Physician Pay Equity and Nurse Practitioner Scope of Practice

Context: Male Family Physicians (FP) earn more than female FPs, in both urban and rural settings. The expansion of nurse practitioners also exerts downward pressure on FP salaries in states where nurse practitioners have Full Practice scope.

Objective: We explore the question, does nurse practitioner scope of practice, by state, impact gender differences in FP salaries? Does this difference remain constant across urban and rural practice settings?

Study Design and Analysis: We used multivariate analysis of variance to explore FP salary differences by gender (Gender Gap), and differences by nurse practitioner scope of practice regulations (Scope Gap) by state, urban/rural distinction based on county of practice, controlling for physician gender.

Setting or Dataset: We use data from the American Board of Family Medicine National Graduate Survey from years 2017 through 2021 (n = 7,058), combined with 2022 state-level Scope of Practice regulation data from the American Association of Nurse Practitioners.

Population Studied: Family Physicians providing patient care within three years of completing residency.

Outcome Measures: “In the most recent tax year, what was your pretax clinical income, combined from all sources, including bonuses but excluding benefits (yours alone, not household)?” Income is adjusted to 2021 dollars using the CPI.

Results: Overall male FPs earn $38,000 more than female FPs, though the pay Gender Gap varies from $32,000 in Full Practice NP States compared to $40,000 for both Reduced & Limited Practice NP states. Male FPs in Full Practice states see a negative $10,000 Scope Gap (e.g., males in Full Practice states compared to all males) while, females see a negative $3,000 gap. While the same Scope Gap pattern holds for metropolitan, micropolitan, and non-metro areas, the overall Gender Gap is lower in metropolitan areas regardless of nurse practitioner scope.

Conclusions: Nurse practitioners in Full Practice states have the effect of driving down male physician salaries to a greater extent than female physician salaries, reducing the overall Gender Gap in physician salaries.