Nurse practitioner training and local medical provider supply.

The Nurse Practitioner (NP) workforce expanded rapidly from 2010-2023, especially in rural counties, where patients today are nearly as likely to receive care from an NP as from a physician. At the same time, rural health outcomes and access to health care continue to worsen relative to urban areas. Empirical research on how NPs interact with or substitute for physicians remains limited. This paper exploits county-level openings of graduate nursing programs to test how they impact the local supply of NPs and primary care physicians. Using data from the Integrated Postsecondary Education Data System and Area Health Resource Files, we estimate staggered difference-in-differences frameworks. We show that new graduate programs lead to large increases in the local NP supply and find positive spillover effects for nearby rural counties and counties with low provider to population ratios. We find that over the decade after a program first graduates students, up to 30% of students become licensed NPs in the same county, and for rural programs, the majority of graduates add to the regional supply of NPs. We find no adverse impact of local NP increases on the number of primary care physicians, suggesting that broader access to NP education boosts the local supply of providers overall. This paper illustrates the importance of rural medical education in increasing local access to primary care providers and in addressing existing inequities in access to care.