As the healthcare industry changes and more Americans become insured, the clinical roles of nurse practitioners (NPs) and physician assistants (PAs) have grown. While that growth is clearly a response to greater need, opinions about the shifting care paradigm are not universally shared.
According to a recent report from the Kaiser Family Foundation, 58 million people live in areas where access to primary care is considered insufficient.
This is not a problem experts expect to diminish. The Association of American Medical Colleges estimates that demand for physicians will exceed availability by as many as 90,000 individual providers by 2025. Roughly one-third of the shortfall is expected to be among primary care providers.
Meeting a Need
In both primary care and specialty fields, advanced practice providers such as PAs and NPs have stepped in to help meet the growing need. It takes less time — six years compared with 11 or 12 for a medical doctor — for advanced providers such as NPs to complete their education and training.
“We don’t feel like we’re providing mid-level care,” says Cindy Cooke, DNP, FNP-C, FAANP, President of the American Association of Nurse Practitioners. “We provide cost-effective, quality care. Nurse practitioners see a great need for high-quality health care for patients across the country. We can supply the numbers. There has been significant growth in the number of nurse practitioners. There are over 205,000 across the United States.”
Not only has the number of these providers completing programs each year increased, so have their clinical duties, responsibilities and freedoms. A Kaiser Family Foundation report says NPs are capable of providing between 80 and 90 percent of the same type of care as primary care physicians.
Case in Point
In Washington state, Group Health Cooperative is one organization that has embraced the use of advanced practice providers to enhance availability and quality of care. This nonprofit healthcare system is based in Seattle and has more than 600,000 individuals in the care of its providers.
David Kauff, MD, is an urgent care provider and Medical Director of Graduate Medical Education for Group Health Cooperative. In his practice and throughout the organization, he has witnessed the role of advanced care providers change in the past several years.
“There has been an increase both in terms of the number [of advanced care providers] and in terms of the scope of practice,” Dr. Kauff says. “The distinctions between advanced care providers and MDs have become less. Their training in some ways is better than some MDs.”
For an example, Dr. Kauff relates that in his urgent care setting, he frequently works with PAs whose extensive training in orthopedics or wound care gives them an edge over their physician associates.
Throughout Group Health Cooperative, advanced care providers are assuming more leadership roles as well, even at the highest levels of the organization. Melissa Szocik, PA-C, is a member of the board of Group Health Physicians, Group Health Cooperative’s physician group. This is an elected position, meaning her peers promoted Szocik to this role — a testament to her abilities as a provider and the value of her input and direction.
Washington is one of 21 states, along with the District of Columbia, that have extended the right to NPs to manage their own practices — something Group Health Cooperative has embraced. Now, some NPs with the organization carry and manage their own groups of patients, independent of physician oversight.
“Nationally, people have realized that these [providers] are tremendously skilled and trained ...,” Dr. Kauff says. “The idea of moving away from being a physician extender to actually a real provider and partner is a great positive.”
Despite the trend toward increased advanced care provider utilization, positive impressions of this change in role are not universal. A recent report from The Commonwealth Fund and Kaiser Family Foundation found that 41 percent of surveyed physicians thought increased reliance on advanced care providers had a negative impact on their ability to care for patients.
The number who considered relying on providers such as NPs and PAs as having a negative impact was lower among physicians who actually utilized such providers in their practices. Approximately 35 percent of that group of physicians said the impact was negative, compared with 40 percent who thought it was positive.
Advanced care providers expressed higher levels of satisfaction with the amount of collaboration they experience in the office setting, though the majority of both advanced care providers and physicians said they were somewhat or very satisfied with collaboration levels.
Cooke sees acceptance and growth of advanced care providers in practice settings as a mix of successes and challenges.
“Being recognized as a key component in the healthcare arena is becoming more and more common,” she says. “There are some federal and state statutory barriers that we continue to work to eliminate so that we can provide the highest quality of care. We all need to work together in order to advocate for the patient to receive the highest quality care that they need.