There are 150,000 nurse practitioners in the US. All but 1,000 of them serve patients in a medical practice run by MD's. This article describes a clinic that is run and operated by nurse practitioners in a rural area that has difficulty attracting MD's to serve the population. The nurses spend twice as much time with their patients per visit than the typical MD because they are on salary. Most doctors are paid on a fee for service basis. They have an incentive to serve more patients per hour. The nurses can prescribe drugs and they refer patients to hospitals and specialists as needed. They are especially good at treating patients with chronic diseases because they can spend more time with them learning about their lifestyles and diets which are critical in the treatment of many chronic illnesses.
Studies have shown that patients in these clinics do as well as similar patients in clinics operated by doctors. Their patients get first class services and they lower costs by reducing the use of expensive hospital emergency rooms. We would probably have more clinics operated by nurse practitioners if there were fewer regulations that restricted their use in many states. They also receive lower fees for their services from Medicare. They receive 85% of what a MD would be paid. Medicaid will only pay for their services if a bill is submitted by a MD. The clinics have to retain virtual MD's to submit bills for the services rendered along with information about the patient.