With the looming primary-care physician shortage, rising cost of healthcare and anticipated surge in patients, the need for physician assistants and nurse practitioners has never been greater.
Perhaps a sign of the times, patients' acceptance of these clinicians as qualified caregivers on par with their regular MDs is at an all-time high.
A recent online study of more than 1,500 US adults, conducted by Harris Poll on behalf of the American Academy of Physician Assistants found that 93% of Americans who have interacted with a PA—including those who have accompanied a loved one to see a PA—in the last year agree that PAs are going to be part of the solution to address a shortage of healthcare providers.
However, there are still some legislative and regulatory barriers that limit NPs and PAs' ability to practice medicine to the full extent of their education and experience.
"We're still be working to be named as Medicaid providers in every part of the country," AAPA president John McGinnity, a Detroit-area PA specializing in cardiology, tells Healthcare Dive. "PAs cannot provide hospice care in any states for Medicare patients. You can have a PA care for a patient for 20 years, but when that patient gets into a hospice situation, the PA can't care for the patient anymore."
However, as PAs are also one of the country's fastest-growing professions, increasing by more than 200% over the last decade, McGinnity anticipates federal and state laws will become more flexible.
"PAs have doubled in size every decade since the 1960s," says McGinnity. "If you go back to the mid-90s, there were 54 PA programs in the country. Today there's 191 programs in the country. More patients are more accepting of us as more and more people are being treated by a PA. That's huge if we're going to improve healthcare."
For Teri Bunker, a nurse practitioner and owner of Bridge City Family Medical Center in Portland, OR, which employs two NPs and three naturopathic physicians, patients' perception of her skills have changed dramatically since she began practicing 15 years ago. But while patients love Bunker, there are limitations that stymie her ability to practice medicine.
"Patients no longer call up and ask automatically to see a doctor; I find that I don't have to explain the difference between a NP and MD very often," says Bunker. "[However], the Medicare rule that says that agencies cannot accept orders from NPs for services of home health. The state of Oregon says it is totally within my scope to order nursing care but the Medicare ties the hands of the agencies by trumping Oregon law and telling the agency that they cannot get paid for any services ordered by a NP. This is so ridiculous. An advanced practice nurse who has a doctorate of nursing cannot order nursing care and get Medicare to pay for it. But if a physician orders it they will pay for it."
Bunker says she has been to Washington, DC, three times in the past 16 years to lobby for changes to this rule. Currently, every time a bill gets introduced it never gets attached to something that will pass.
The latest bill, the bipartisan Home Healthcare Planning Improvement Act of 2013, which seeks to allow NPs, clinical nurse specialists, certified nurse midwives and physician assistants to order, certify eligibility and sign home health orders, was introduced in the US House of Representatives as HR 2504 in June 2013 but was not acted on last year, she notes.
"I am hoping that we can remove the barriers and allow everyone to practice at the top of their license," says Bunker. "Primary care should be handled primarily by nurse practitioners, physician assistants ... We also need to have Medicare funded residencies for primary-care providers, including NPs, as this is the only real difference in the way we are trained."