How the Primary Care Physician Shortage is Boosting Nurse Practitioner and Physician’s Assistant Demand
This year marks the 50th anniversary of the launch of the Nurse Practitioner and Physician’s Assistant professions. Fittingly, opportunities for nurse practitioners and physician assistants have never been better.
You can thank, in part, the looming primary care physician shortage. Fewer physicians are entering primary care, and those who do are opting to work fewer hours. Combine that with an increasing demand for services by a growing and aging population (the latter of which includes graying primary care providers eyeing retirement) and a recent hike in the number of Americans with insurance coverage, and the United States is looking at a shortfall of an estimated 20,400 primary care physicians within the next five years.
Enter nurse practitioners and physician assistants. With five decades of evidence pointing to the high-quality, cost-effective care these trusted professionals provide, the health care industry is hailing NPs and PAs as the solution to what otherwise might be a primary care crisis. In fact, the National Center for Health Workforce Analysis estimated that full deployment of NPs and PAs could ease the primary care physician shortage by two-thirds.
The demand for NPs and PAs is now at an all-time high. Here’s a look at how Nurse Practitioners and Physician’s Assistants are positioned to fill the void and alleviate the primary care shortage.
What Nurse Practitioners and Physician’s Assistants Do
On the surface, nurse practitioners and physician assistants perform many of the same duties, but their roots are in different disciplines.
Nurse practitioners, a type of advanced practice registered nurse, are educated in the nursing model of care, which emphasizes the wellbeing and health of the whole person versus a symptom-based approach to care. Many NPs hold previous experience as an RN, and all hold at least a master’s degree (although doctor of nursing practice degrees are becoming more and more common).
According to the American Association of Nurse Practitioners:
- More than 205,000 nurse practitioners are currently licensed in the United States.
- More than 86 percent of nurse practitioners are prepared for primary care roles.
- Nurse practitioners routinely diagnose and treat health conditions, order lab tests and other services, prescribe medications, and teach patients about disease prevention.
Physician assistants, meanwhile, are educated in the medical model of care and are authorized to practice under the supervision of a physician, who then delegates the specific duties the PA may perform. Most PAs earned a bachelor’s degree and worked in health care before deciding to spend an additional two years in an accredited PA program to practice as a physician assistant.
According to the American Academy of Physician Assistants:
- More than 90,000 physician assistants are currently certified in the United States.
- Nearly a quarter of physician assistants work in family medicine; 4 percent more work in general pediatric or pediatric subspecialties.
- Physician assistants routinely diagnose and treat illnesses, order lab tests and other services, prescribe medications, and provide patient education.
Both NPs and PAs are known for their high rates of patient satisfaction and quality care. What’s more, both are less costly than physicians. In 2013, nurse practitioners garnered an average annual salary of $98,817; physician assistants, $107,268, ADVANCE for NPs & PAs found. Family physicians, according to a 2012 Forbes report, earn an average $189,000 a year.
Fuller NP Practice Scopes in Sight?
Where things become contentious, particularly for nurse practitioners, is how much physician involvement their state requires in their practice. Some states allow NPs to practice fully independent of any physician involvement; others require them to “collaborate” with physicians in order to perform certain duties, such as prescribing controlled substances (how loosely or rigidly the required collaboration is differs, again, by state).
Scope-of-practice battles between NPs and physicians are nothing new, but the anticipated primary care shortage has garnered more influential voices— such as the Institute of Medicine, the National Governors Association and the Federal Trade Commission — to lobby on behalf of greater practice independence for NPs. (AARP and the Robert Wood Johnson Foundation are also NP supporters.) Nurse-managed clinics, which rely on NPs as the main providers of health care, are already public health staples in many underserved rural and urban areas. If more states allowed nurse practitioners to practice independently, supporters argue, patient access to primary care would spread regardless of the physician shortage.
“Costly and unnecessary barriers to NP practice continue to exist, impeding both NPs and physicians from working to their fullest capacity,” stated a recent Health Affairs blog post. “The unnecessary requirements in numerous states for physicians to sign orders for physical therapy or other referrals, supervise NPs, or sign off on numerous other documents waste precious physician time and are not feasible in the real world.”
As the legislative battles continue, primary care practices are relying more heavily than ever upon NPs and PAs to supplement their provider base. How their growing popularity will play out in various state capitol debates, however, remains to be seen.
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