Mid-Level Providers Trending Away from Primary Care?

Congressional lawmakers are quietly advancing a bill that will probably have an immediate transformative impact upon primary care delivery, once the ACA kicks in. The bill (HR 2810) which aims to revamp Medicare also contains an amendment that would reward all medical providers (not just physicians) running a medical home for chronic care management. Physician lobbying groups are pressing hard for only their recognition in such plans. It’s enough to deal with this as a potential problem for physicians, as nurse practitioners have heft on their side: QA organizations such as the NCQA also recognize patient-centered medical homes run primarily by primary care NPs. An interesting battle looms on this front. But, it’s not the only one.

A new study is out that details a growing number of mid-levels (both NPs and physician assistants) are going on to subspecialty work, with fewer than half of PAs choosing primary care ambulatory medicine. Efforts to incerease primary care provider numbers have been trending toward the mid-level supply side for a few years now, as studies like this seem to corroborate federal studies on the matter. Both of these issues seem to portend an unintended consequence of the ACA and its impact on primary care healthcare delivery: all providers agree that there is a potential mismatch between demand within increasing access under the ACA, and that, if physician orgs want that demand met — as I do — perhaps efforts to increase corroboration and planning and to decrease turf wars are in order.