Nurse Practitioners & Physician Assistants: A Solution For The Primary Care Dilemma

Kevin Fickenscher, MD, CEO AMIA

Kevin Fickenscher, MD, CEO AMIA

While we all await the Supreme Court decision on the Obama health-care law, there is growing recognition that we are facing a looming shortage of primary care providers in the coming decade.  The Association of American Medical Colleges predicts that the country will have 63,000 too few doctors as soon as 2015.  In fact, if the Supremes sustain the Obama legislation, the 32 million newly insured Americans who will be added to the system could very well precipitate a workforce crisis.  What to do?  How to solve the problem?

The American Academy of Nurse Practitioners recently launched a public service campaign to raise the profile of the nation’s 155,000 nurse practitioners.  I’ve been a big fan of nurse practitioners since my residency days.  I worked side-by-side in my residency with nurse practitioners.  Nurse mid-wives taught me obstetrics.  I practiced with a nurse practitioner in my clinical practice.  The physician-nurse practitioner team is very good because training is different and we focus on different aspects of the individual’s health.  I have always felt that as a team the MD-NP dyad was stronger than either one practitioner individually.

There are lots of healthcare politics related to the issue, like “independent” practice and “scope of practice” requirements.  Regardless of how one feels on those issues, it seems clear to me that we should invest heavily in training not only nurse practitioners, but also physician assistants.  We desperately need more primary care providers and the most expeditious approach toward increasing the number quickly would be to increase our investment in the NP/PA model.

In a sign of the times, legislative analysts have noted a marked increase in state legislation related to the role of healthcare practitioners.  In fact, state legislators have introduced more than 400 such bills this year related to healthcare practitioner roles.  The number of bills represents a marked increase from prior years in recognition of the growing crisis and the state’s rights role of licensure.  We should expect that with a primary care shortage, the NP/PA approach will become a staple of the new accountable care/patient-center care models that are evolving quickly across the U.S.  And, by teaming –– we’ll actually see much better healthcare.