Family Nurse Practitioner Autonomy and Physician Collaboration in Rural vs Urban Settings


  • Stacy Stellflug, PhD, APRN, FNP-BC Montana State University
  • David Auerbach, PhD Brandeis University


Purpose: Policymakers are increasingly interested in using nurse practitioners (NPs) to provide health care to rural populations, yet little is known about NP autonomy and physician collaboration. The purpose of this study was to examine NP autonomy and collaboration with physicians based on practice setting.

Sample: We obtained data from the 2018 National Sample Survey of Registered Nurses (NSSRN). For our analysis, we included NPs certified as Family Nurse Practitioners (FNPs) who indicated they cared for their own panel of patients.

Methods: We grouped the FNPs by practice setting; Critical Access Hospitals, Rural/Underserved Settings, and Urban Settings. We compared indicators of FNP practice autonomy and physician collaboration based on practice setting.

Findings:  FNPs practicing in rural settings were more likely to have a collaborative practice relationship with a physician, less likely to bill under their own National Provider Identification number, and less likely to feel as though they were considered equal colleagues with physicians.

Conclusion: The rural physician population is aging out and is not being replaced by younger physicians. To meet the need of rural and underserved populations, NPs are in a unique position to step into the care void. Increasing NP autonomy and reducing barriers to practice will be essential aspects of NP practice going forward.

Keywords: Family Nurse Practitioners, Rural Practice, Physician Collaboration


Author Biographies

  • Stacy Stellflug, PhD, APRN, FNP-BC, Montana State University

    Associate Professor, Mark and Robyn Jones College of Nursing

  • David Auerbach, PhD, Brandeis University

    Visiting Scholar, Heller School for Social Policy and Management