News Release

Successful Medicare initiative increases the supply of nurse practitioners to address primary care shortages

Peer-Reviewed Publication

University of Pennsylvania School of Nursing

PHILADELPHIA (January 4, 2022) – A new study published today in Health Affairs shows that Medicare support for clinical training for nurse practitioners would increase their numbers and address the national shortage of primary care. The study, by researchers at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, the Hospital of the University of Pennsylvania, and the Leonard Davis Institute of Health Economics shows that universities participating in the $200 million Graduate Nurse Education (GNE) Demonstration significantly increased the number of  primary care NPs they graduated. Co-author Linda Aiken, PhD, RN, said “One in four Americans, or over 80 million people, lack a primary care provider. Nurse practitioners with advanced clinical training in primary care help the public obtain health care when they need it. There are plenty of qualified applicants to university NP programs but admissions are limited because we don’t have enough primary care clinicians to supervise student learners in their practices.”

The Graduate Nurse Education Demonstration, launched under the Affordable Care Act, provided selected hospitals with Medicare funding to help offset costs associated with clinical training of NPs. The funded hospitals were the Hospital of the University of Pennsylvania in Philadelphia, PA; Duke University Hospital in Durham, NC; Rush University Hospital in Chicago, IL; Scottsdale Healthcare Medical Center in Scottsdale, AZ: and Memorial Hermann-Texas Medical Center in Houston. These hospitals created partnerships with university NP educational programs. The largest of the funded sites was the Hospital of the University of Pennsylvania, which served as a regional hub for a network comprising 9 universities with NP graduate programs, multiple hospitals and health systems, and many community-based primary care practices.

Co-author Regina Cunningham, PhD, RN, Chief Executive Officer of the Hospital of the University of Pennsylvania, said, “The GNE Demonstration shows that longstanding challenges in health care like the shortage of primary care providers can be successfully addressed when health care organizations in communities band together for the common good. Working together in Philadelphia across health systems, public clinics, private medical practices, and schools of nursing, we were able to recruit a larger number of practicing physicians and nurse practitioners to mentor NP students to help them meet their clinical training requirements of 500 or more hours thus enabling nursing schools to accept more student NPs.”

First author Joshua Porat-Dahlerbruch notes, “The cost of clinical training for one nurse practitioner in the GNE Demonstration was about $47,000 compared to the cost of clinical training for a primary care physician of over $157,000.”  The GNE funds were used to support preceptors mostly practicing in community-based settings.

The GNE Demonstration also showed the success and feasibility of using regional consortia to distribute Medicare training funds to a limited number of hospitals for training nurse practitioner students. This is a promising way to modernize Medicare graduate medical education to produce more of primary care providers that this country needs.      

Funding for the study was from the Centers for Medicare and Medicaid Services and the National Institute of Nursing Research/NIH.    

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Study Citation 

Porat-Dahlerbruch, J, Aiken LH, Todd B, Cunningham RS, Brom, HM, Peele, ME, & McHugh MD. Policy Evaluation of the ACA Graduate Nurse Education Demonstration. Health Affairs 2022; January 4.  .

About the University of Pennsylvania School of Nursing  

The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing. For the sixth year in a row, it is ranked the #1 nursing school in the world by QS University. In a first for any undergraduate Bachelor of Science in Nursing (BSN) program in the country, our BSN program is ranked # 1 in the 2022 U.S. News & World Report’s Best Colleges rankings. Penn Nursing is also consistently ranked highly in the U.S. News & World Report annual list of best graduate schools and is ranked as one of the top schools of nursing in funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: FacebookTwitterLinkedIn, & Instagram.  

About Penn Medicine

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $8.9 billion enterprise.

About the Leonard Davis Institute

The Leonard Davis Institute of Health Economics at the University of Pennsylvania has since 1967 been the leading university institute dedicated to data-driven, policy-focused research that improves our nation’s health and health care. Penn LDI connects all twelve of Penn’s schools, the University of Pennsylvania Health System, and the Children’s Hospital of Philadelphia through its more than 300 Senior Fellows. See more at and on Twitter @PennLDI. 

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