Nurse Practitioners to Take Increasing Role in Healthcare

Larry Hand

July 09, 2012

July 9, 2012 — The number of nurse practitioners (NPs) could grow by 94% by the year 2025, and they will likely provide a growing amount of healthcare services as demand increases during implementation of the Affordable Care Act, according to an article published in the July issue of Medical Care.

Author David I. Auerbach, PhD, from the RAND Health, Boston, Massachusetts, predicts that the number of full-time NPs will increase to 244,000 in 2025, up from 128,000 in 2008, based on regression analysis modeling for population sizes and ages. An NP is defined as a registered nurse (RN) who has completed formal NP education and is employed in nursing. Using lower and higher modeling scenarios, the growth ranges from 227,000 to 268,000 NPs in 2025.

"When we redefine NPs as those working in nursing and who consider their position title to be 'NP,' the workforce grows (under the same assumptions as the default forecast...) from 86,000 [full-time employees] in 2008 to 198,000 [full-time employees] in 2025, representing a higher rate of growth (130%)" than that seen in the default forecast, Dr. Auerbach writes. "This faster growth likely stems from the fact that a steadily growing proportion of those educated as NPs have considered their position title to be NP — from 47% in 1992 to 63% in 2000 to 67% in 2008."

What Do the Predictions Imply?

Dr. Auerbach's projections have 3 main implications for healthcare:

First, recent forecasts have projected that physician shortages could reach as high as 90,000 physicians in the coming decade, and the ratio of physicians to NPs could fall from 5:1 to 3:1 overall and from 4.1:1 to 2.3:1 in primary care in 2025.

Second, if the "mix of primary care providers" shifts toward a higher ratio of NPs to physicians, transitional difficulties could develop as healthcare practices work to define and clarify new roles to achieve optimum team performance.

Third, quality of care has to be considered.

Previous research has concluded that in practices in which NPs have provided care in place of physicians, the quality of care has been similar or better, he writes. "Yet, that literature was concerned with existing and prior models of care. In the long run, as models of care provision among providers of mixed backgrounds and training mature, there may be further improved outcomes as suggested by some literature, as a result of the different but complementary foci of NP and physician training and approaches to patient care," he writes.

Dr. Auerbach writes that the forecasts add urgency to the need for adoption of healthcare models in which NPs, RNs, and physicians work in complementary roles as a team.

Although the growth in numbers of NPs has been steady since 1992, at approximately 6000 per year, and is likely to continue at a rate of from 6000 to 7000 a year, the age structure has been steadily changing over the years, Dr. Auerbach notes. The percentage of NPs older than 50 years doubled, from 22% in 2000 to 44% in 2008. However, that percentage is expected to plateau during the next few years, to decrease to about 36% in 2021, and then to start to rise again.

"Although large numbers of NPs will retire in the coming decade, new cohorts of NPs are entering the workforce in ever larger numbers and appear poised to more than offset the retirements," Dr. Auerbach writes.

Factors that could cause deviation from these forecasts include possible adoption of a doctoral requirement for new NPs, as recommended by the American Academy of Colleges of Nursing. Such a change for pharmacists has resulted in decreased supply, at least short-term, Dr. Auerbach writes.

In addition, a limitation of forecasts is the reliance on small numbers of observations during a time frame. Dr. Auerbach based his projections on data from the National Sample Survey of Registered Nurses (NSSRN) conducted by the US Health Resources Services Agency, plus age-distribution data from the American Academy of Nurse Practitioners. The NSSRN sample population included from 30,000 to 35,000 licensed RNs (1% - 2%) every 4 years between 1992 and 2008.

The author has disclosed no relevant financial relationships.

Med Care. 2012;50:606-610. Abstract