While nurse practitioners (NPs) acting as support are a relatively normal occurence in most medical settings, concierge nurse practitioners running their own retainer-based arrangements are emerging as a recent industry trend.
Given that nurse practitioners are also considered primary care providers, they have historically helped the primary care landscape in expanding healthcare capacity and maintaining the consistency of patient care.
However, like many things in American healthcare as of late, things are changing with respect to nurse practitioner roles in direct primary care.
The reason behind this change is the law of supply and demand.
According to recent projections by the Association of American Medical Colleges (AAMC), the U.S. population is projected to grow by 8.4% by 2036.
Moreover, the population aged 65 and older is projected to grow by 34.1%. Americans tend to require more healthcare and physician access as they age.
With a projected physician shortage of up to 86,000 by 2036, the industry is scrambling to meet these patient requirements and is now turning to primary care nurse practitioners to help fill the demand.
In this blog, we dive into the qualifications and scope of work of concierge nurse practitioners, the pros and cons of having nurse practitioners in concierge medicine settings, and whether they are allowed to run their own practices to begin with.
The shortage of primary care physicians in the U.S. has led to the growth of concierge medicine career opportunities for NPs.
Case in point, the United States of Bureau of Labor, as of 2023, ranked ‘nurse practitioner’ as 1 of the top 2 jobs expected to experience the highest growth in demand within the next decade.
Of course, there are two sides to every coin and the rise of nurse practitioners in concierge medicine has its benefits and drawbacks.
Some benefits include:
NPs can provide more accessible care to patients, as they are often more readily available than physicians.
In many instances, NPs offer great value in terms of helping doctors run a smooth, efficient practice. New concierge clinics typically work within a tight budget, therefore hiring administrative managers may not always be possible.
Given their comprehensive training and natural interest in patients, NPs are able to perform administrative roles well within clinic settings.
NPs can provide high-quality care at a lower cost than physicians, making concierge medicine more affordable for patients.
NPs are trained to consider the whole person – physical, emotional, and social – when providing care, leading to a more comprehensive and integrated approach to health.
NPs can devote more time to each patient, providing personalized attention and care.
NPs can focus on preventive care, helping patients maintain good health and prevent chronic diseases.
NPs can provide continuity of care, as they are often the primary care provider for patients in concierge medicine practices.
Patients often report high satisfaction with NP care, citing the personalized attention and care they receive.
On the other hand, some cons worth considering are:
NPs may have limited scope of practice in some states, which can impact their ability to provide comprehensive care.
In some states, NPs may be required to practice under the supervision of a physician, which can impact their autonomy and ability to provide care.
In line with nurse practitioner laws that differ per state, there is a lack of standardization in NP education and training, which can impact the quality of care provided.
Nursing education in the U.S.is not uniform and can vary significantly depending on which state you receive your degree.
Although there are national standards and guidelines for nursing education, each state has its own specific requirements and regulations.
Program length, curriculum, clinical training hours, and even faculty qualifications are some of the variables that vary across states.
NPs may face liability concerns, particularly if they are practicing independently. As of 2024, standard regulatory clarity across states has not been achieved.
This makes running their own practice very tricky for nurse practitioners in concierge medicine, as there is a long list of restrictions and regulations to take note of per state.
Some patients may have expectations that NPs are not able to meet, such as prescribing certain medications or performing certain procedures.
NPs may face reimbursement challenges, particularly if they are not recognized as primary care providers by insurance companies.
First off, let us settle the score — nurse practitioners and advanced practice registered nurses (APRNs) are often used interchangeably, although they are not exactly the same.
APRN is an umbrella term that encompasses four types of advanced practice nursing roles:
Certified Nurse Practitioner (CNP): Provides primary and specialty care to patients, including diagnosing, treating, and managing acute and chronic illnesses.
Certified Nurse Midwife (CNM): Provides prenatal, delivery, and postpartum care to women, as well as gynecological and reproductive health services.
Certified Registered Nurse Anesthetist (CRNA): Provides anesthesia care to patients undergoing surgery, as well as pain management and critical care services.
Certified Nurse Specialist (CNS): Provides specialized care to patients with specific conditions or needs, such as pediatrics, oncology, or cardiology.
NPs are a specific type of APRN who are educated and trained to extend primary and specialty care to patients. Nurse practitioners are certified in a specific patient focus, such as:
To summarize, NPs are APRNs, although not all APRNs are NPs. APRNs are a broader category in which nurse practitioners fall under.
Mid-level healthcare professionals, such as PAs and NPs, play an important role in the medical ecosystem.
Because they are healthcare professionals who have received training and education on top of licensure and certification but are not physicians, they are great allies in extending care.
They also play crucial patient-facing roles, ensuring that practices and medical facilities run smoothly and efficiently.
Although PAs and NPs share lots of similarities, here are a few key differences:
PAs have a master's degree in physician assistant studies, which includes classroom instruction and clinical training. The average PA program lasts 24-28 months long.
NPs, on the other hand, have a master's or doctoral degree in nursing, with a focus on advanced practice nursing. NP programs are normally 2-3 years long and include classroom instruction and clinical training.
After passing the Physician Assistant National Certifying Examination (PANCE), PAs are required to undergo certification by the National Commission on Certification of Physician Assistants (NCCPA).
After receiving certification, PAs are qualified to conduct physical exams, diagnose and treat illnesses, order and interpret tests, provide counsel on preventive healthcare, assist in surgery, as well as write prescriptions.
While the level of supervision varies per state, PAs typically work under the supervision of a physician. This is because they do not undergo the same level of comprehensive training as physicians or other mid-level medical professionals.
In contrast, NPs are certified by a national certifying organization, such as the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP), after passing a certification exam.
NPs have more freedom whether to work independently or in collaboration with physicians, depending on the state.
Nurse practitioners are medical professionals who have completed graduate-level education and training in a certain specialization, may it be primary care, pediatrics, or gerontology.
On top of that, NPs in the U.S. are required to undergo approximately 500 hours of clinical training.
NPs are trained and licensed to diagnose, treat, and manage acute and chronic illnesses, order diagnostic tests, prescribe medication, and provide health education to patients.
In retainer-based arrangements such as concierge medicine and direct primary care (DPC), NPs play an important role in delivering patient care and maintaining patient satisfaction.
Much like DPC physicians and concierge medicine doctors, what’s great about independent nurse practitioners in private practice is that they can report anywhere and adjust to the needs of their patients.
Nurse practitioners in concierge medicine extend care well beyond the confines of a health center. They are able to care for their patients at home, in hotel rooms, in offices — you name it.
Their scope of work includes:
NPs provide routine check-ups, health screenings, and vaccinations, as well as diagnose and manage common medical conditions, such as hypertension, diabetes, and asthma.
NPs work with patients to develop personalized care plans, monitor their condition, and adjust treatment as needed.
NPs focus on preventive measures, such as health education, nutrition counseling, and lifestyle coaching, to promote wellness and prevent disease.
NPs often serve as a liaison between patients and specialists, ensuring seamless communication and coordination of care.
NPs take the time to educate patients about their conditions, treatment options, and self-care strategies, empowering them to take an active role in their health.
The answer to this question varies per state.
There are three categories a nurse-led concierge medicine practice can fall under:
In the U.S., 23 states plus the District of Columbia have granted Full Practice Authority (FPA) to NPs. In these states, NPs are allowed to:
FPA states include: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wyoming.
In 16 states, NPs have Reduced Practice Authority (RPA). In these states, NPs are required to:
RPA states include: Alabama, Arkansas, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.
In 11 states, nurse practitioners in concierge medicine have Restricted Practice Authority (RRA). In these states, NPs are:
RRA states include: California, Illinois, New York, and Washington D.C. (although NPs have Full Practice Authority in the District of Columbia, there are some restrictions).
For more information on the State-by-State Guide to Laws Regarding Nurse Practitioner Prescriptive Authority and Physician Practice, click here.
As a patient, if you are considering a nurse practitioners in concierge medicine, it is crucial to assess the following:
Concierge nurse practitioners are becoming an integral part of American healthcare.
They continue to be a godsend when it comes to filling in the gaps in primary and specialty care as well as helping offset the demand for quality patient care.
As of 2024, there are over 385,000 licensed NPs practicing in the U.S., with 88% of them certified in primary care. This is a great win for American healthcare because more primary care providers mean increased accessibility, holistic care, and cost-effective treatment.
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