So, have you heard about the physician shortage—how by 2020, it is estimated that the United States will have approximately 200,000 fewer practicing physicians than the nation will require to meet the increasing needs of a growing, aging, chronically ill population? The Association of American Medical Colleges (AAMC) has already called for a 30% increase in medical school enrollment, but “even with that increase, demand is going to be significantly higher than the supply,” says Edward S. Salsberg, MPA, Director of AAMC’s Center for Workforce Studies.
It may please NPs and PAs to know they are not alone in considering their professions an important part of the solution to the problem. Both groups “play a major role in our thinking about the future,” Salsberg says. “The only way we can balance the need for services and assure access [to care] is if we use more PAs and NPs, and use them more effectively.”
And the Numbers Are …
There is no doubt that the NP and PA professions are thriving. Data from the National Commission on the Certification of Physician Assistants indicate that the number of newly certified PAs in the US has increased from about 1,000 in 1990 to nearly 5,000 last year. “That fivefold increase is enormous,” Salsberg says, “and it means the number of PAs will be rising significantly over the next several decades.”
Data on NPs are a little harder to gather, since there are multiple training models and certification programs; if you consider advanced practice nurses as a group, there are nearly 10,000 new APNs each year. Geraldine Bednash, PhD, RN, FAAN, Executive Director of the American Association of Colleges of Nursing (AACN), says, “For the last decade, we’ve seen enormous growth in the number of individuals who have been educated as NPs and who are practicing as NPs.”
Salsberg is uncertain as to what impact the switch to the Doctor of Nursing Practice (DNP) degree will have on the NP supply. “That does have the potential to slow up the pipeline for several years. So I don’t know what [NPs’] growth rate will be,” he says. “I’m sure it will be significant. I just don’t know whether there will be a delay in the growth.”
Bednash considers that “a reasonable question” but says AACN believes the DNP will actually attract more candidates to NP programs. “We’re seeing people choose graduate school earlier in their careers, so it should expand the number of people who are entering the programs,” she observes. “The big issue for us will not be whether it takes longer [to get NPs educated and into the workforce] but whether we can continue to graduate the same or larger numbers of people every year.” So far, she says, the numbers have continued to rise.
Tweaking the Data
But sheer volume may not be enough to offset the physician shortage. Much like clinical trial results, the NP/PA workforce supply is subject to a number of variables. Roderick S. Hooker, PhD, PA, Director of Rheumatology Research at the Dallas Veterans Affairs Medical Center, who has done extensive analysis of health care supply and demand, tries to be conservative in his own estimates.
“When I look at what the outpatient productivity in the US is on an annual basis, it’s about 1.2 billion outpatient visits,” he explains. “And when we look at who’s minding the store—who’s seeing those patients—the provider of record in about 11% to 13% of cases is a PA or NP. So, while the head count is larger for both camps, the productivity number is small.”
Furthermore, Hooker notes, not all PAs or NPs who are certified (the basis on which most estimates are generated) may be seeing patients. They may have chosen an academic or leadership role that keeps them out of the clinic. Hooker estimates that the number of PAs who are in active practice could be as much as 12% lower than the stated figures.
Both Salsberg and Hooker say more research is needed to determine whether there will be enough NPs and PAs available to offset the physician shortage. “What is the optimal number?” Hooker asks. “Only when we have an optimal number, what people think is the right ratio of ‘doctor to population,’ will we be able to answer that question.”
Salsberg says “better information on the numbers and types and locations of practitioners … would help us do a lot more forecasting. Both professions are growing very rapidly, [but] I don’t know whether we need more [PAs and NPs] or whether the growth we’ve seen in the last 15 years is going to be sufficient.”