Faculty, Funding, and Preceptors
Then there are the practical obstacles to NP and PA education programs maintaining, let alone ramping up, “production.” These are the same problems that have plagued the nursing and medical education systems for years: faculty, funding, and preceptors.
AACN’s Bednash says her organization sees the DNP as part of the solution to the nursing faculty shortage: “To some extent, the work that’s being done to prepare people at the doctoral level for advanced practice will both produce a very high-quality clinician and expand the ability to have people who can serve in faculty roles.”
Foundations, individual institutions, and employers are also developing ways to support graduate nursing education; for example, AACN is working with the California Endowment to provide funding for minority nurses in California to pursue higher education. “The funding they receive from us is based on their commitment to us that they will stay in California and serve as a faculty member for several years,” Bednash says.
Meanwhile, “the bottleneck for the PA programs tends to be clinical sites, not the classroom,” Hooker notes. “You can teach a classroom of 200 people the same way you can teach a classroom of 20. It’s getting people dispersed into preceptorship sites that I think is the conundrum.”
Solutions to that problem have been slow in developing. Hooker, who describes himself as “more of an observer than an activist” (ie, he does not advocate for particular solutions but points out different ways of doing things as food for thought), notes that in Canada and Australia, preceptor sites are purchased as part of the tuition for a program. “They give some remuneration to the mentor, and while it’s not much, it is a very important price signal,” he says. “And that price signal says, ‘We value the time that you spend, and we’re willing to compensate you for it.’”
Whatever solutions are proposed or pursued, the bottom line involves funding: more of it. “[Policy makers] need to focus on graduate education,” Bednash says. “They need to fund the programs so that they can hire additional faculty to expand, and they need to understand that doctoral-level education is the only way somebody is going to be able to have a long-term career in a university and serve as a faculty member.”
Generation Next and the Evolution of Team Care
Finally, there is one other factor—a more sociological one—that could have an impact on the health care workforce supply. That is the younger generation’s desire for a better work/life balance than their parents and grandparents had. As Bednash observes, “The expectation [used to be] that you would work morning, noon, and night, weekends, ’round the clock, forget your family.”
That attitude toward work appears to be changing, regardless of profession. “So the question there is, who’s going to work those nights and weekends?” Salsberg asks. “Someone is going to need to be available, and it remains to be seen [who it will be].”
Bednash says practices will have to consider how to balance work schedules and patient care needs “so no one profession ends up having the right to preferential expectations about how that work life should play out. It probably means there will need to be more physicians and more nurses so that all the care needs can be met.”
Besides a greater interest in a 9-to-5 job (or close to it), Hooker also detects a growing sense of wanderlust among people in their 30s and younger. “These people, to me, seem to be delaying marriage, delaying commitment, very interested in going abroad,” he observes. “I wouldn’t be surprised if over the next 10 years we find young Americans emulating Canadians, Australians, the Swiss, and others, and wanting to go abroad—with their skills. I’m wondering if American PAs won’t want to bring their newly honed skills to the world stage and say, ‘I’m a PA, and I’d like to work in the Netherlands for two years’ or ‘I’d like to work in Australia for a few years. It’s a great country, and I want to see the world.’”
The chance that any or all of these factors could impact the supply of NPs and PAs in the coming years brings us back to Salsberg’s original point about creating a more effective health care team. Here, too, he says, research is needed. “I’m a very strong believer in expanding the use of NPs and PAs,” he says, “but I do believe that should really be driven by evidence. What kind of services does it make sense for someone with, say, six years of post–high school [education] to do, and what do you really need those 12 or 13 years of post–high school education for?”