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Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential
  1. Claudia B Maier1,2,
  2. Hilary Barnes3,
  3. Linda H Aiken3,
  4. Reinhard Busse4
  1. 1Harkness & B. Braun Fellow in Healthcare Policy and Practice; Center for Health Outcomes and Policy, Research University of Pennsylvania, School of Nursing, Claire Fagin Hall, Philadelphia, Pennsylvania, USA
  2. 2Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
  3. 3Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Department of Healthcare Management, Head of the Berlin Hub of the European Health Observatory on Health Systems and Policies, Technische Universität Berlin, Berlin, Germany
  1. Correspondence to Claudia B Maier; c.maier{at}


Objectives Many countries are facing provider shortages and imbalances in primary care or are projecting shortfalls for the future, triggered by the rise in chronic diseases and multimorbidity. In order to assess the potential of nurse practitioners (NPs) in expanding access, we analysed the size, annual growth (2005–2015) and the extent of advanced practice of NPs in 6 Organisation for Economic Cooperation and Development (OECD) countries.

Design Cross-country data analysis of national nursing registries, regulatory bodies, statistical offices data as well as OECD health workforce and population data, plus literature scoping review.

Setting/participants NP and physician workforces in 6 OECD countries (Australia, Canada, Ireland, the Netherlands, New Zealand and USA).

Primary and secondary outcome measures The main outcomes were the absolute and relative number of NPs per 100 000 population compared with the nursing and physician workforces, the compound annual growth rates, annual and median percentage changes from 2005 to 2015 and a synthesis of the literature on the extent of advanced clinical practice measured by physician substitution effect.

Results The USA showed the highest absolute number of NPs and rate per population (40.5 per 100 000 population), followed by the Netherlands (12.6), Canada (9.8), Australia (4.4), and Ireland and New Zealand (3.1, respectively). Annual growth rates were high in all countries, ranging from annual compound rates of 6.1% in the USA to 27.8% in the Netherlands. Growth rates were between three and nine times higher compared with physicians. Finally, the empirical studies emanating from the literature scoping review suggested that NPs are able to provide 67–93% of all primary care services, yet, based on limited evidence.

Conclusions NPs are a rapidly growing workforce with high levels of advanced practice potential in primary care. Workforce monitoring based on accurate data is critical to inform educational capacity and workforce planning.

  • nursing
  • health workforce
  • physicians
  • nurse practitioner

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