- The healthcare industry is facing a primary care physician shortage that threatens patient access to care in coming years. Leaning on non-physician clinicians such as nurse practitioners (NPs) and physician assistants (PAs) could reduce the enormity of that problem, according to a recent report from the United Health Group.
Currently, 13 percent of US patients live in a county with a primary care shortage, defined as having less than one primary care physician (PCP) per 2,000 patients.
The primary care shortage impacts both rural and urban areas, although its effects are more concentrated in rural areas. Patients living in rural areas are five times more likely to live in a county with a PCP shortage compared to individuals living in urban or suburban areas.
However, the number of patients living in urban or suburban areas experiencing a provider shortage is nearly equal to the number of patients living in rural areas experiencing the same thing – 21 million patients versus 23 million, respectively.
These shortages occur because there simply are not enough primary care physicians, with only 288,000 out of 869,000 physicians choosing the PCP path. Going forward, this disparity is slated to worsen. By 2030, there will only be 306,000 PCPs in the nation.
And as time wears on, PCPs are going to age into retirement. By 2025, one-third of the providers practicing today will be over age 65 and will be preparing for retirement.
There is little primary care interest among new graduate student classes, the UHG report continued. In 2017, only one in six medical school graduates chose a primary care residency.
These disparities mean physicians will need to work extensive hours to treat their patients. A PCP with a typical patient panel of 2,000 patients will need to work over 17 hours each day to deliver the requisite level of primary care, chronic care management, and acute care.
The doctor shortage is not the only problem. Patient demand for primary care is also increasing.
By 2030, demand for primary care will increase by 38 percent among the over-65 population, and by 55 percent for the over-75 crowd. For all age groups, demand will increase by 8 percent.
But the influx of older adult patients presents a challenge, especially considering their propensity to develop chronic illnesses. The number of adults over age 65 living with at least one chronic illness is expected to increase from 43 million to 59 million by 2030, UHG predicts.
This means that the proportion of patients with and without a chronic disease will skew – currently 10 million patients do not have a chronic illness and 43 million do. By 2030, 14 million patients will not have a chronic disease compared to the 59 million that UHG projects.
Non-physician clinicians, such as nurse practitioners and physician assistants, are well-positioned to address the physician shortage in primary care. These professionals undergo extensive training, with NPs focusing on disease prevention and health management, two core tenets of primary care.
Both NPs and PAs receive at least a master’s degree, with many NPs opting to advance to a doctoral degree. For their part, PAs must complete over 2,000 hours of clinical rotation.
What’s more, NPs and PAs have a documented interest in primary care. Seventy-eight percent of nurse practitioners – 204,000 out of 262,000 – practice primary care, a far cry from the 33 percent of physicians to specialize in primary care.
Twenty-eight percent of PAs practice primary care, as well.
NPs and PAs are expected to continue their interests in primary care. On average, 16,000 nurse practitioners graduate from a primary care education program, and by 2025 UHG predicts the number of NPs practicing primary care will increase by 47 percent. For PAs, primary care specialists are expected to increase by 38 percent.
However, some obstacles exist for fully tapping NPs to fill primary care gaps. Currently, only 22 states grant NPs full scope of practice, meaning that nurse practitioners can practice to the top of their training unsupervised. Sixteen states allow NPs some practice autonomy, but will enforce limits such as prescribing medications only in certain quantities.
Twelve states require NPs to practice under the direct supervision of a physician at all times.
States should consider relaxing their scope of practice laws, UHG recommended. If more states expanded these regulations, the nation would see a significant decrease in primary care physician shortages.
Following expansion of NP scope of practice, the number of patients living in a county with a PCP shortage would go down from 44 million to 13 million nationwide. In rural regions, that proportion would decrease from 23 million to 8 million, a near 65 percent reduction.
Because of the potential benefits, UHG suggested industry leaders reconsider scope of practice laws for NPs. Leaning on non-physician clinicians is a cost-effective way to ensure there are more primary care providers who can meet growing patient demand, UHG said in an accompanying blog post.
“These advanced practice clinicians practice independently or as part of multidisciplinary care teams that help primary care practices care for more patients,” the organization wrote. “A meaningful, timely opportunity to increase primary care capacity is to allow NPs to practice to the full extent of their education and training.”