June 5, 2018
Dive Brief:
- 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.
Dive Insight:
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.
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