Tuesday, February 5, 2013

 Can Nurse Practitioners and Physician Assistants Solve the Doctor Shortage? Not Without Some Changes
As physician assistants and other midlevel health professionals fill growing gaps in primary health care, turf battles are erupting in many states over what they can and can’t do in medical practices.
Melinda Beck, “Battles Erupt Over Filling Doctors’ Shoes: As the Ranks of Physician Assistants and Other Health Professionals Grow, States Weigh Loosening Some Restrictions,” Wall Street Journal, February 4, 2013
February 5, 2013 – Current estimates are that  there will be a shortage of 100,000 doctors by 2020 and 150,000 by 2025. 
Will the current crop of 180,000 nurse practitioners and 86,500 physician assistants,  expected to grow by 20% to 30% by 2020, be enough to take the pressure off the primary care doctor shortage?
No one knows for certain. 
It depends on:
·         how successful  medical schools will be incentivizing more medical students to join the ranks of primary care.

·           government paying  primary care doctors more to treat Medicare and Medicaid patients. 
·          government funding more primary care residency programs. 

·         states expanding on what NPs and PAs can do, e.g. acting autonomously to do certain things without supervision,  writing prescriptions for controlled substances,  removing chest tubes, prescribing physical therapy,  charging patients directly for their services.

·         NPs and PAs  choosing to work for primary care physicians rather than specialists ( currently only 31% of PAs work for primary care physicians) 

·         How successful medical homes and other “physician-led, patient-centered medical homes” will be.

·         If the pay of NPs and PAs,  now averaging about $86,000, continues to escalate, drawing more into these professions.

·         If patients become more and more accepting of being seen by NPs and PAs rather than by physicians.

Many of these things are unknown at present or are evolving.  But on the whole,   NPs and PAs have positive and growing  roles to play, e.g. prescribing routine medications, performing routine procedures,  running retail clinics  and in the case of NPs, setting up independent practices.
Who is now caring for patients?  According to various sources – American Academy of Physician Assistants, AMA, Association of Medical Colleges, American Nursing Association,  and Bureau of Labor Statistics,  the caring professions include;  768,000 doctors,  180,000 nurse practitioners,  86,500 physician assistants,  and 2.6 million registered nurses. Patients will continue to be good hands, but not without some turf disputes and restrictions along the way.

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