"In 18 states (disproportionately but not exclusively rural ones) and the District of Columbia, a nurse practitioner can examine, diagnose, and treat patients in a primary care context. Nurse practitioners also get paid less than doctors. Medicare reimburses them at 85 percent of the doctors' rate, for example, but they also charge less to insurance companies and out-of-pocket patients. And since the "blue states" in this sense are a pretty diverse lot, we can get pretty good quasi-experimental data as to whether cheaper nurse practitioners are actually any worse than primary care doctors in this regard. The answer is a resounding no."Here's a map of where NPs can and cannot practice independently, by the way.
Granted, nurse practitioners aren't able to replace specialist doctors, but since newer physicians are heavily skewed away from being primary care doctors in the first place (and have been for about a decade), allowing more nurse practitioners to step in seems only too logical. This is especially true given the scope of our primary care shortage and the fact that it takes a lot less time to train new nurse practitioners than it does to train new doctors. The Affordable Care Act sought to remedy this shortage by raising primary care physician payment rates under Medicare and Medicaid, but that's a modest and insufficient solution to such a daunting problem.