Date of Graduation


Document Type


Degree Name

Doctor of Philosophy in Public Policy (PhD)

Degree Level



Political Science


Brinck Kerr

Committee Member

Barbara B. Shadden

Second Committee Member

Geoboo Song


Social sciences, Health and environmental sciences, Advanced practiced nurses, Affordable Care Act, Primary care physicians, Registered nurses


The Affordable Care Act (ACA) changed the national discussion about who is the decision-maker in healthcare delivery – physicians or others that pay the bill. The federal government is the largest payer of healthcare services while states are responsible for implementing the ACA’s features. Through the ACA, the federal government endorsed non-physician primary care by advanced practice registered nurses (APRN). The research question of this study is: Why do some primary care physicians support independent autonomous practice for advanced practice registered nurses while others do not? The research question should be important to policy-makers because physicians are the predominate purchasers of healthcare services. However, dilemmas facing policy-makers as they adopt and implement the ACA are rapidly increasing public costs and demands for healthcare services that cannot be met by physicians alone. This study investigates ideology and PCP support for the ACA as influences on PCP opinions about APRNs. A web survey was offered to 2995 physicians practicing adult primary care in five states. Dichotomous groups were established from responses to the study’s independent variables. Group mean responses computed from questions relating to physicians’ opinions about APRNs were compared using the independent means t test. Results of bivariate testing find that ideology, support of the ACA, and whether physicians work with APRNs may influence physician opinions. Demographic characteristics including age, gender, and race are not related to physicians’ opinions about APRNs.