Comparing prescribing practices of nurse practitioners and physicians in the United States: A scoping review

BACKGROUND: Nurse practitioners (NPs) in the United States have an expanding role in medication prescribing and management as professional autonomy increases. PURPOSE: To synthesize up-to-date, US-based evidence on NP and physician prescribing with respect to quality, patterns, and longitudinal trends. METHODOLOGY: We searched Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, and PsycINFO (June 2024-December 2025) for US quantitative studies published since 2000 comparing NP and physician prescribing quality, patterns, or trends. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework, three reviewers screened 3,031 records with consensus resolution. RESULTS: A total of 17 studies were included. Prescribing quality was generally comparable between NPs and physicians, although findings related to opioid and antibiotic prescribing were mixed. Prescribing patterns varied by medication type and practice setting, with NPs accounting for a higher proportion of psychotropic and chronic disease medications and greater use of noncontrolled or over-the-counter medications in rural areas. Over time, NP prescribing increased, opioid prescribing declined, and adoption of newly approved medications was slower than physician prescribing. CONCLUSIONS: NP prescribing is generally comparable to physician prescribing across several quality indicators, with variation observed by medication type, outcome measure, and clinical context. IMPLICATIONS: The findings support the integration and expansion of NP-provided medication management as a means of meeting patient care needs without compromising quality. Variation in NP prescribing across medication types and practice settings highlights the importance of supporting NP prescribing roles with resources and clinical supports that are tailored to therapeutic area and practice setting.