- With an ongoing physician shortage, primary care practices are increasingly turning to nurse practitioners and other interdisciplinary provider scenarios to fill the care delivery void, a new study in Health Affairs finds.
- In 2016, NPs represented a quarter of the provider workforce in rural practices and 23% in nonrural practices — up from 17.6% and 15.9%, respectively, in 2008.
- NPs were most prevalent in states with full scope-of-practice laws. However, the fastest growth was seen in states with reduced and restricted scopes of practice.
The Association of American Medical Colleges estimates a shortfall of as many as 105,000 doctors by 2030. In primary care, that number could reach 43,000. Meanwhile, the U.S. population is expected to grow by about 2.3 million people each year between now and 2030, according to U.S. Census Bureau data.
NPs are a potential way to mitigate the physician shortage while also improving care coordination and population health efforts.
In the face of these trends, the AAMC began pushing for higher medical school enrollment in the early 2000s — a drive that has seen both an increase in the number of medical schools and in matriculants. The group is also focused on interprofessional teamwork to increase the use of NPs and physician assistants.
Edward Salsberg, director of health workforce studies at George Washington University’s Health Workforce Institute, believes such a team approach can help solve the physician shortage problem. “While the number of new physicians is growing slowly, the number of NPs and PAs is growing very rapidly, as is a whole host of other professions,” he told Healthcare Dive via email earlier this year. “Making better use of the workforce we have through innovations in service delivery and modifications in scope of practice laws/regulations can help increase access, improve quality and constrain the growth in health care costs.”
According to the Health Affairs study, the number of NPs is rising annually, with 87% educated to provide primary care. “Policymakers could further encourage these trends by continuing to invest in NP education and training and by facilitating direct reimbursement for NP-delivered care,” the authors write.
They point to the Affordable Care Act’s Graduate Nurse Education Demonstration, which reimbursed five hospitals for the cost of training NPs in primary care. The pilot sunsets next month, with no plans for further funding. Direct reimbursement of NP services could also incentivize practices to use NPs at the top of their practice. “Both strategies can be accomplished in ways that benefit a variety of stakeholders, including patients,” the study says.