MDNews - Minnesota

Special Edition 2013

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With the PRimaRy caRe PRoviDeR shoRtage eXPecteD to intensify When 30 million ameRicans gain health coveRage unDeR the affoRDable caRe act (aca), some inDustRy eXPeRts aRgue that Physician assistants (Pas) anD nuRse PRactitioneRs (nPs) Will bRiDge the caRe gaP. hoWeveR, DemanD foR these PRofessionals is also outPacing suPPly. A CroSS the NatioN, the news is the same: There are too few primary care physicians. According to American Medical News, typical practicing physicians and physicians in training receive three to five solicitations for employment every week, with a few physicians receiving 50 or more recruitment letters weekly. And the Association of American Medical Colleges (AAMC) estimates that more than 46,000 primary care slots will be unfilled by 2020. On the other hand, in many states, depending upon scope-of-practice laws, NPs and PAs are taking over much of the load of primary caregiving — so much so that some analysts call the predicted worsening of the physician shortage greatly exaggerated. Writing in the journal Health Affairs, Linda Green, a Professor at Columbia University's Graduate School of Business, a rg ued that PAs and NPs could fill the primary care slots. The AAMC disputes that. In an interview with The Washington Post, Atul Grover, Chief Public Policy Officer with AAMC, cites scope-of-practice and reimbursement issues as reasons why NPs and PAs will not be able to close the care gap resulting from the primary care provider shortage. Data on current recruitment patterns bolsters this view: NPs and PAs are being hired quickly to fill a variety of roles, but like physicians, PAs tend to steer toward specialty fields, and NPs and PAs alike are entering a market in which demand exceeds supply. the Potential of Non-Physician Medical Professionals Often called "physician extenders" or "midlevel providers," PAs and NPs look forward to an increased role in health care as the physician shortage continues. NPs, in particular, advocate the expanding of scope-of-practice laws so that they have more responsibility for patient care. Meanwhile, professional organizations such as the American Association of Nurse Practitioners (AANP) want Medicaid and Medicare reimbursement patterns to be unshackled from the physician supervision requirement. At present, only 18 states allow NPs to diagnose, treat and prescribe without at least some degree of supervision by physicians. "NPs are uniquely qualified because they start out as nurses; they have a deep connection and trust with patients and their families, with added education and training," says Maryjoan D. Ladden, PhD, Senior Program Officer, Human Capital Portfolio, the Robert Wood Johnson Foundation, and an NP. "There has been an increase in enrollment with both nurse practitioner and physician assistant programs over the past several years. The majority goes into primary care. It makes sense to look at how to use everybody to the top of their education and training so we can fill the gaps in primary care. This is the gateway into health, where you focus on prevention and help people avoid getting, or having complications from, chronic disease." A policy statement by the Robert Wood Joh n s on Fou nd at ion ident i f ie s nonphysician providers as uniquely suited to delivering patient-centered care, such as that found in accountable care organizations MdNewS.CoM ■ MD News Twin Cities | 39

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