Physician Shortage

The Solution to the U.S. Physician Shortage? Nurse Practitioners

Guest Post by Sophia Bernazzani

Our country is facing a primary care provider shortage crisis. This is largely due to population growth, aging trends and the implementation of the Affordable Care Act (ACA).

However, there is a solution to the U.S. physician shortage: advance practice nurses — such as nurse practitioners who complete graduate education through family nurse practitioner programs.

Nurse practitioners have the clinical skills and practical training to meet the needs of our country’s growing insured and aging population. This is especially true in rural areas and in community health care settings where physicians are few and far between. Here, we’ll take a look at the factors causing the physician shortage, how nurse practitioners can fill the growing need, and what that means for individuals planning to either start or advance their careers in health care.

America’s Physician Shortage

There are a number of factors that are contributing to the growing physician shortage in this country, including an aging population, the expansion of preventive care benefits and the implementation of the ACA — which has increased health insurance coverage to an estimated 27 million Americans over the past five years. Combined, these trends have experts agreeing that the current and projected physician workforce will be unable to meet the health care needs that result.

In fact, by 2020, the Health Resources and Services Administration forecasts a shortage of 20,400 primary care physicians if the current framework for care remains the same as it is today. In some geographic pockets of the country, known officially as Health Professional Shortage Areas, the current and expected shortage is even worse. The supply of primary care physicians relative to the population in these regions is below federally defined standards.

The proportion of individuals living in such places varies, but in almost half of the states, it’s at least 20 percent of the population — and it’s more than 30 percent in at least six states. Overall, compared to the rest of the world, the U.S. lags in the number of physicians — averaging 2.5 per 1,000 people versus an average of 3.2 per 1,000 in other Organization for Economic Co-operation and Development nations.

Why Nurse Practitioners Are the Answer

The good news is that there is an answer to the physician shortage — expanding the use and availability of nurse practitioners (NPs) as primary care providers. Nurse practitioners have completed graduate-level education and have the clinical skills and knowledge to provide direct patient care. With graduation rates continuing to rise, the number of practicing NPs is expected to double over today’s workforce — reaching approximately 410,000 by 2025.

As a recent Kaiser Family Foundation publication notes, close to 90 percent of all NPs are prepared in primary care, and many practice in primary care settings: “Primary care NPs are significantly more likely than primary care physicians to practice in urban and rural areas, provide care in a wider range of community settings, and serve a high proportion of uninsured patients and other vulnerable populations. Studies show that NPs can manage 80-90% of care provided by primary care physicians.”

The foundation further cites studies that show that optimal primary care outcomes, including patient satisfaction, “are comparable between patients served by NPs and patients served by physicians.” In fact, some studies show that patient satisfaction is actually higher when they receive care from an NP. According to a Health Affairs brief, “Studies found that nurse practitioners do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services.

The patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care.”

A Strategic Career Move

As the Institute of Medicine (IOM) notes, “The Affordable Care Act created new health delivery and payment models that emphasize teamwork, care coordination, value, and prevention: models in which nurses can contribute a great deal of knowledge and skill. Indeed, the nursing profession is making a wide-reaching impact by providing quality, patient-centered, accessible and affordable care.”

The nursing profession as a whole is making significant contributions to support the new model of health care that’s needed to adapt to the evolving needs of society. For those considering a career in nursing — or for nurses who are looking to advance established careers — becoming a nurse practitioner is a strategic move.

With the current and looming physician shortage, there is great need and much opportunity for NPs to fill the need for primary care providers in a variety of settings — and achieving this primary provider status can be completed in much less time than is required for physicians.

Though states govern the scope of NP practice, NPs should be allowed to serve as primary care providers in all 50 of them. In fact, the IOM recommends a model of “Full Practice,” in which “State law provides for nurse practitioners to evaluate, diagnose, treat, and prescribe under the exclusive licensure authority of the state board of nursing.”

In addition, anticipating the increased demand for care with its implementation — and recognition of the role that NPs play in helping to meet demand — the ACA included several new initiatives to help pay for graduate nursing education, including the Graduate Nurse Education Demonstration and increased funding for the National Health Service Corps.

Although there is much hand-wringing about the expected physician shortage, there are solutions that can be implemented now and included in future planning. Making the most of what nurse practitioners have to offer as primary care providers is a win-win for everyone involved — including those considering a career in this exciting field.

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