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fo Rc es to b e R ec ko n eD With NurSe PraCtitioNerS + Approximately 180,000 are practicing in the united States. + NPs typically hold a master of Nursing or doctor of Nursing Practice degree. + Seventy-five percent practice in primary care. (Sources: Kaiser Family Foundation, National Institute for Health Care Reform) PhYSiCiaN aSSiStaNtS + About 90,000 are practicing in the united States. + PAs typically hold a master's degree in medical science or physician assistant studies. + forty-three percent practice in primary care. (Sources: American Academy of Physician Assistants, Agency for Healthcare Research and Quality) and patient-centered medical homes. The statement cites studies in which care provided by NPs and physicians in a primary care setting resulted in similar outcomes in terms of health as well as greater patient satisfaction among patients of the NPs — possibly because these professionals spent more time consulting with patients. The studies are cited to support expanded scope-of-practice laws and less restrictive reimbursement practices. In a similar vein, the National Governors Association urges states to broaden scope-ofpractice laws to allow more NPs to provide primary care in less restrictive settings. At t he b o ot s- on-t he-g rou nd le vel, scope-of-practice debates tend to give way to practicalities. For both NPs and PAs, necessity can be the mother of invention: Where the need is great, practices are doing what they can to make up the shortfall of primary care providers at any level. Grundy County, Tenn., for example, has only 10 physicians, whether primary care providers or specialists, among a population of nearly 14,000. A PA came out of retirement to preside over a free clinic in her house. The overseeing physician visits monthly, while the PA and a volunteer staff see patients regularly, according to the Chattanooga Times Free Press. "NPs ser ve r ura l a nd underser ved communities more than our physician colleagues do," says Angela Golden, DNP, F N P - C , FA A N P, C o - P r e s i d e n t o f the AANP. "If you look at the United States as 40 | Twin Cities MD News ■ MdNewS.CoM a whole, we do not have enough primary care providers, but for rural areas, that disparity increases. With enrollment in nurse practitioner degree programs up by 50 percent in the past two years, the piece we are going to fill is that gap in numbers. We will probably account for the largest increase in primary care providers between now and 2025." M o v i n g t h e d e b a t e f r o m u n d e rserved communities to the business of medicine, Travis Singleton, Senior Vice President with national healthcare staffing company Merritt Hawkins, a division of AMN Healthcare, also argues that market forces, not legislation, are driving the move toward non-physician providers for primary care. "Scope of work is more an argument about belief systems than objectives," he says. "What we have seen over the past two years is that as massive primary care networks have been built, that decision [of how responsibilities are divided among physicians, NPs and PAs] has been taken out of the individual physician's hands. Instead of physicians with varying degrees of co-management with non-physicians, you have huge systems buying up primary care practices." Without enough physicians to meet demand, Singleton says, these systems began "employing NPs and PAs at rates never seen before." a Shortage of their own Despite so much interest in expanding the reach of care for NPs and PAs, these providers, like primary care physicians, may not be graduating in sufficient numbers to satisfy demand. Consider: + St a f f ing compa n ies a re f ind ing it difficult to meet demand for PAs and NPs. According to a much-reported 2013 study by Staff Care, requests for PAs and NPs increased from just 2 percent of temporaryplacement inquiries to 10 percent in only two years. Of those inquiries, says Michelle Hoogerwerf, Divisional Vice President, Advanced Practice and Radiology, with Staff Care — also a division of AMN Healthcare — 88 percent are for primary care positions. + Texa s faces a shor tage of PA s a nd NPs alike, according to Emily Merrill, RN, PhD, Professor and Department Chair for Nurse Practitioner and Nurse Midwifery Studies at Texas Tech University Health Sciences Center. Due to a teacher shortage, there simply aren't enough slots for prospective students, she told the Abilene Reporter–News. + To encourage medical providers to work in underserved portions of the state, Mississippi lawmakers attempted in 2013 to exempt some of NPs' income from taxation if they were practicing in "critical shortage areas." Though the bill failed, it suggests, at a minimum, a keen awareness that the midlevel provider supply is finite.

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