By Marcia R. Faller, PhD, RN, chief clinical officer and senior vice president, AMN Healthcare
April 2, 2013 - Depending on who you listen to, the shortage in primary care physicians is either a crisis or an opportunity. The Association of American Medical Colleges projects shortages of 91,500 physicians in 2020 and 130,600 physicians in 2025. And at each of those points in time, approximately half of the shortage is expected to be in primary care. From that vantage point, the primary care physician shortage is a crisis, because the new medical models advanced by healthcare reform are team approaches with primary care physicians anchoring the team.
In these integrative models, patient care, wellness programs, assessments, behavioral health and other services are all spokes off the hub of primary care. So primary care physician shortages would mean a shortage of hubs--and without hubs, wheels don’t work.
Not to worry, others say. Physician assistants (PAs) and advanced practice nurses, such as nurse practitioners (NPs), will pick up the slack.
Researcher David I. Auerbach, PhD, at RAND Corporation, says that the number of NPs will grow 57 percent to 244,000 by 2025, while the number of physician assistants will grow 73 percent to 128,000 by the same year. What’s more, Auerbach says, patient-centered medical homes (PCMHs), a preferred team-approach model, can use a lot more NPs and PAs, and therefore fewer physicians.
But, as of today, only a small fraction of patients are cared for under patient-centered medical homes, and a new survey from Staff Care, an AMN Healthcare company, shows that providers are already having trouble meeting demand for nurse practitioners and physician assistants. One research report from University of Pennsylvania School of Medicine has shown that there will be substantial shortages, not a surfeit, of these clinicians. It’s not clear whether there will be enough NPs and PAs to fill the primary care gap -- or whether state laws will allow them the autonomy to fully undertake primary care duties.
Currently, most states, including the most populous ones, require physician involvement for NPs to prescribe, diagnose and treat. Less than half the states give NPs the autonomy they would need to provide robust primary care services. Thus, a turf war over questions of autonomy for advanced practice nurses and physician assistants is underway, with approximately 1,800 scope-of-practice bills being considered in various state legislatures.
So what’s the answer to the primary care physician shortage? It’s bound to be a complex, multi-faceted approach to optimizing all the roles in the primary care workforce, while helping clinicians and other staff truly work together as teams―and that will take innovative healthcare employers, staffing companies, educators and policymakers working together to address the issue.
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