Reimagining primary care delivery: Evaluation of nurse practitioner–owned primary care practices

Nurse practitioner (NP)-owned practices play a growing role in primary care, especially in underserved communities. Although states with full practice authority (FPA) have seen increased NP self-employment and improved care access, little is known about the operational realities and challenges of NP-owned, insurance-based practices. This study aims to characterize NP-owned primary care practices, focusing on access, service delivery, financial sustainability, and challenges unique to NP practice ownership. A concurrent mixed-methods design combined survey responses (n = 19) with electronic health record data from NP-owned practices across six FPA states. Most practices were solo owned, women/minority led, and fee-for-service dominant. Nearly 90% offered telehealth and same-day appointments, with average panel sizes of 867 patients-smaller than national averages. Despite high levels of patient access, challenges included inadequate reimbursement (79%), administrative burden (74%), and limited value-based care (VBC) participation. More than one third reported financial instability, and 84% expressed confidence in long-term sustainability. Nurse practitioner-owned practices deliver accessible, patient-centered care in underserved areas but face systemic barriers to scalability and financial sustainability. Nurse practitioner-owned practices enhance health care access but face financial and administrative barriers. Nurse practitioner-owned practices are well positioned to meet the growing primary care needs, but changes to support equitable reimbursement and expand VBC participation are essential for sustainability.