Working as a Family Nurse Practitioner in Underserved Communities

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Access to primary care is becoming increasingly limited, especially in underserved communities.


The United States is facing a primary care crisis. According to the Henry J. Kaiser Family Foundation (KFF), access to primary care is becoming increasingly limited due to a combination of population growth, patient aging/expanded life span, and expanded health insurance coverage under the Affordable Care Act (ACA).

A related issue is the aging of America’s primary care physician workforce. “The Complexities of Physician Supply and Demand,” a recent study by the Association of American Medical Colleges, warns of a shortage of between 46,000 and 121,900 doctors by 2032.

“The major factor driving demand for physicians continues to be a growing, aging population,” an April 2019 press release about the report notes, adding that “one-third of all currently active doctors will be older than 65 in the next decade. When these physicians decide to retire could have the greatest impact on supply.”

Rural and historically underserved areas are expected to be most affected by the shortage.

The solution to this problem may lie partly in the hands of non-physician primary care workers such as family nurse practitioners (FNPs). To solve the coming crisis, many states are granting full practice authority to permit FNPs to function at the full scope of their training, thereby permitting them to provide more diagnostic and therapeutic services to patients.

FNPs can also be trained much more quickly than physicians – in about 6 years of study, compared to 11 or 12 for a full medical degree. Nursing programs such as Ohio University’s online MSN are seeing students take advantage of this fact by seeking FNP certification.

With a growth rate of about 30%, the nurse practitioner workforce “could potentially reduce the expected shortage of primary care providers in 2020 by about two-thirds … if they are effectively integrated into the health care delivery system,” the KFF says.

Educational options such as Ohio University’s online MSN program are helping to lay the groundwork for this future. OHIO’s MSN program prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for advanced careers as family nurse practitioners (FNPs), many of whom will find success and satisfaction nursing in underserved communities.

What Is an Underserved Community?

Underserved communities are those with too few primary care providers compared to the population. The criteria are fixed by law and are monitored by the U.S. Health Resources & Services Association (HRSA). Officially called Health Professional Shortage Areas, or HPSAs, underserved communities fall into three categories:

  • Geographic areas. A location with a shortage of providers for the entire population within a defined geographic area.
  • Population groups. A population with a shortage of providers for a specific group or groups within a defined geographic area. Examples might include low-income residents or migrant farmworkers.
  • Facilities. A place without enough medical professionals to properly serve its clientele. Correctional facilities and mental health facilities often meet these criteria, but any facility can be designated as an HPSA if its staff is inadequate for its needs.

Although HPSAs can and do occur anywhere in America, rural communities tend to stand out as an area of greatest need, followed closely by deep urban communities. These communities often have trouble attracting young medical professionals and are particularly vulnerable when aging physicians retire.

Added Benefits

Why should a nurse practitioner consider working in an underserved community? There are many reasons. Erin Tolbert, a former family nurse practitioner turned medical expert, lays out several compelling arguments in a recent article:

  • Job opportunities. Underserved areas are in desperate need of medical help, and this creates more job opportunities than ever before for FNPs. The opportunities are particularly marked in rural areas. “This primary care gap presents a promising job market,” Tolbert says.
  • Greater autonomy. Tolbert states that nurse practitioners often practice with greater autonomy in underserved communities. They fulfill the traditional role of the primary care provider and play a more significant role in caring for their patients. For many FNPs, this leads to a higher level of job satisfaction.
  • Financial rewards. Looking specifically at underserved rural communities, the lower cost of living compared to the city can be a draw. At the same time, rural providers often make more money than their urban counterparts. “Higher pay compensates for the inconveniences of rural living, ultimately leading to a much better quality of life,” Tolbert says.
  • Loan repayment assistance. Providers practicing in medically underserved areas qualify for student loan reimbursement from the federal government. The National Health Service Corps (NHSC) offers up to $60,000 toward outstanding student loans for just two years of practice in some HPSAs. In an area with slightly less medical need, a repayment of $40,000 is offered. This financial assistance can be a powerful incentive to those saddled with hefty educational loans.

Making a Difference

All of these benefits may be well and good — but can FNPs in underserved communities really make an impact? Absolutely, according to the research. The KFF cites studies showing that NPs can manage 80 to 90% of care provided by primary care physicians. In addition, many studies show that primary care outcomes, including disease-specific physiologic measures, improvement in pathological condition, reduction of symptoms, mortality, hospitalization, and patient satisfaction are comparable between patients served by NPs and those served by physicians. NP’s and physicians make great teams to manage care in these underserved areas.

This being said, other regulatory bodies, such as the National Conference of State Legislatures, see a need for increased educational and licensure standards for unsupervised FNPs. They would also like to see improved data collection to increase accountability and ensure quality of care. Health care is an evolving landscape that will change the role of FNPs in years to come — in ways that likely will add responsibility and prestige to the position. By getting involved now, family nurse practitioners can position themselves to ride the wave of coming change and benefit from America’s changing medical landscape.

Ohio University’s Online Master of Science in Nursing (MSN) Program

The online MSN program at Ohio University is designed for practicing RNs who want to advance their expertise in the nursing field. Students in the Family Nurse Practitioner concentration take courses such as Primary Care of Adults and Primary Care Practice.

For more information about the online MSN degree program, MSN degree benefits, and additional concentrations for MSN nursing careers, visit Ohio University’s website.


Recommended Reading:

Steps for Starting a Family Nurse Practitioner Practice

What Does a Family Nurse Practitioner Do?

Career Comparison: Nurse Practitioner vs. Physician Assistant


Access to primary care – Henry J. Kaiser Family Foundation

The Complexities of Physician Supply and Demand – AAMC press release

Expanding the role of nurse practitioners – Henry J. Kaiser Family Foundation

HPSA definition – Health Resources & Services Administration

What NPs can manage – Henry J. Kaiser Family Foundation

Need for increased education and licensure – National Conference of State Legislatures