Medicare reimbursement is 33% less today than it was in 2001. By default, this means ALL insurance reimbursement is at LEAST that much less for primary care. This year – 2025 – it was reduced by another 2.8%. Meanwhile, the cost of goods, including utilities and supplies, has increased no less than 30% over the same time period.
With this widening gap between reimbursement and the cost of providing care, existing primary care practices have had to find ways to decrease their cost of doing business. Many times, this means decreasing the number of staff employed in the office. Meanwhile, the population has increased in both size and age, leading to more people needing primary care. This puts added strains on providers, leading to higher burnout rates, AND longer waiting times for people to be seen by a primary care provider. Wait times nationally are averaging 2 weeks for existing patients. This lead many patients to seek care elsewhere – the emergency department or a walk-in clinic. This leads to fragmented care, meaning worse overall outcomes. Multiple providers treating a patient for the same problems can increase the risk for multiple medications, conflicting information given to patients, and increased cost AND frustration for patients.
These problems have not gone unnoticed by those entering schools for medicine and nursing. They see the problems from the outside and see nothing being done to effectively change them. Seeing this, many are choosing other career paths than primary care, which further exacerbates the problems.
In Florida, the legislature passed the “Live Healthy” package of bills meant to, at least in part, address these problems. However, it didn’t include Advance Practice Registered Nurses (Nurse Practitioners), which left out over 10,000 autonomous nurse practitioners who could have filled the primary care gap on day one of the legislation being signed into law. So we wait. We wait for people to choose primary care as their profession. We wait for them to finish schooling. And we wait for them to decide to go INTO primary care IN Florida.
How much longer CAN we wait!? Primary care has the capacity to enhance life expectancy, improve health outcomes, and lower health care costs. But until or unless our legislators make substantive changes in the existing laws, including allowing TRUE full practice authority and TRUE autonomy, INCLUDING mandating that nurse practitioners be accepted by insurance companies for reimbursement, and be added to hospital medical staff, the situation will only continue to worsen.
Despite being the nation with the HIGHEST GDP investment in healthcare in the word, we have a lower life expectancy than many countries who spend LESS on healthcare. Combine this with increasing rates of chronic disease, and it’s a perfect storm for a total collapse of primary care!
It’s time for a new approach. One that includes, what would be for Florida, fresh ideas. To date, 26 states allow TRUE full practice and autonomy for nurse practitioners. This is NOT a new idea. However, it IS new in Florida. In 2020, Florida granted autonomy to nurse practitioners, but severely limited their scope, limiting their ability to practice. Long story short, this was done to appease physicians, who see nurse practitioners as a cash cow. While on the surface, nurse practitioner autonomy looked great, in actuality, it only worsened the problem. Nurse practitioners are reimbursed at a lower rate than their physician counterparts, and that’s IF insurance companies accept them into their network at all! The legislature didn’t truly address THIS part of the equation. Sure, nurse practitioners can practice independently in limited areas, but they can’t get reimbursed for it. This created a no win situation, and thus only allowed the problems to continue to get worse.
It’s part time for Florida to catch up with reality and allow TRUE full practice for nurse practitioners AND make insurance companies take them into their networks. Anything short of this and patients will continue to suffer, and the failures of the system will only worsen. Primary care is the foundation for ALL healthcare, and should be treated as such! This includes allowing nurse practitioners to practice to the fullest extent of their training and education! There is over a half century of quality research that proves nurse practitioners provide safe, high quality care with similar – and sometimes BETTER – outcomes as physicians! Don’t let the AMA and other physician groups let you think otherwise! Some of that quality research is listed here on this site. Read the studies for yourself, and make up your own mind. Then call or write your state legislators and tell them Florida DESERVES BETTER! Tell them to stop coddling the AMA and other physician groups and give TRUE full practice authority to nurse practitioners! Your health and that of your friends and loved ones depends on it!
