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FACT: There is no data showing that unsupervised NPs/PAs are safe and effective

There are often statements that "five decades" of research shows the safety and efficacy of nurse practitioners and physician assistants. However, they rarely point out one important fact: That every single study on care provided by nurse practitioners and physician assistants was performed under the supervision of physicians, with access to physicians for questions or concerns, or following physician-created protocols.

While studies DO show that NPs and PAs can provide high-quality care when working together with a supervising physician, there are no quality studies showing the safety and efficacy of non-physicians when practicing without physician supervision, following physician-created protocols, or without physician availability to answer questions and provide needed assistance.

The best meta-analysis of nurse practitioner care, a Cochrane review, found only 18 studies of adequate quality over the last 50 years to analyze. Of these, just 3 were performed in the United States. Further, every single study in the Cochrane review involved nurses working under physician supervision or following physician-created protocols.


Yes, even supposedly independent NPs in Mary Mundinger's famous 2000 study were practicing under a collaborating physician, as required by New York statute at the time. In addition, NPs in the study were assigned a physician mentor and received an additional 9 months of training with medical residents.

VIDEO: Reviewing 50 years of research from the Cochrane database

Independent Practice States

VIDEO:  Rebutting Mary Mundinger's claim that her study involved 'independent' NPs

Despite having just 3% of a physician's training when they graduate, nurse practitioners have the right to practice independently at all Veterans Administration facilities and half the states in the Union. 

Physician assistants have gained independent practice in North Dakota, and are seeking independent practice in other states.

If you are being treated by a non-physician practitioner in one of these states, there MAY NOT be a physician overseeing your care and ensuring your safety!

States with completely independent NP

practice immediately upon graduation

  1. Alaska

  2. Arizona

  3. Hawaii

  4. Idaho

  5. Iowa

  6. Montana

  7. New Hampshire

  8. New Mexico

  9. North Dakota

  10. Oregon

  11. Rhode Island

  12. Utah

  13. Washington

  14. Wyoming

The following states allow NPs to practice independently after practicing with physician oversight for a set number of hours 

* Remember that physicians are required to complete 15,000 hours before they are allowed to treat patients independently!

  1. Colorado — 1,000 hours for prescriptive authority 

  2. Connecticut — 3 years and 2,000 hours 

  3. Delaware — 2 years and 4,000 hours

  4. Illinois — 4,000 hours

  5. Kentucky — 4 years

  6. Maine — 2 years

  7. Maryland — 1.5 years 

  8. Minnesota — 2,080 hours

  9. Nebraska — 2,000 hours

  10. Nevada — 2 years or 2,000 hours  

  11. South Dakota — 1,040 hours

  12. Vermont — 2 years and 2,400 hours

  13. Virginia — 5 years and 9,000 hours

  14. West Virginia — 3 years 

  15. Florida - primary care after 3,000 hours

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