NP and PA Growth in the USA Save

Forbes has published a thoughtful perspective on the declining number of US physicians and the growth in the number of advanced practice providers or APPs (nurse practitioners and physician assistants) in the US clinical workforce.

Gastroenterologist Dr. Spencer Dorn writes that in the US, there are fewer physicians per capita (2.6 per 1,000) than most developed nations (average 3.6 per 1,000), with a physician shortfall of 125,000, that is projected to be ~200,000 by 2037.

APP programs began to produce NPs and PAs in 1965, and since the number of NPs and PAs has gradually increased, if not exploded.

• America’s 280,000 NPs and 145,000 PAs comprise one-third of the clinical workforce. 
• APPs provide over a quarter of healthcare visits
• APPs are one of America's fastest-growing professions

APP training differs from MD, residency and fellowship training. NPs are registered nurses who complete 1-3 years of additional training (500-1,000 patient care hours) and PAs complete two to three years of training (2,000 patient care hours). Despite significantly different training, most studies have found physicians, NPs, and PAs provide similar-quality care. (There are some exceptions.)

Dr. Dorn states, "After two-plus decades of practicing medicine, I find it hard to generalize. In my experience, most NPs and PAs are good-to-great, but some are not. The same is true of physicians."

Then again, "Why would we train various professionals completely differently and expect them to practice the same way?"

While NPs, PAs, and physicians have overlapping scopes of practice, we need to be clear on differences (if any) about how each will best meet the population’s health needs.  APPs are trained "to care for their patients and communities", they are "not trying to be physicians".

The big challenges is how to ensure all professionals are well-prepared to practice?  Specialization in a specific discipline is not likely to be taught during APP training and may not be adequately provided as they seek future employment and careers. What is needed is something better than, the "See One, Do One, Teach One" model common to medical training.

With APPs providing increase healthcare services, how should care models best accommodate the needs of the patients, while encouraging the training and interests of the providers.  While, NPs and PAs may be suited to manage well-defined "structured problems" using protocols, they shouldn't be confined to protocol care; just as physicians are not confined to protocolized or limited care models. 

NPs and PAs will be critical to health care, primary care and specialty care shortages. 

Many clinicians have employed or worked with APPs; but many have not and some tend to be territorial or dismissive about changing the healthcare delivery model they are accustomed to. Despite objections, serious, major unmet needs lie ahead abd will require some progressive thinking and new practices. 

Regardless of which side you fall on, I encourage you to read this article in Forbes.