Nurse Practitioner Workforce

A Substantial Supply of Primary Care Providers

Lusine Poghosyan, Phd, Mph, Rn; Robert Lucero, Phd, Mph, Rn; Lindsay Rauch, Bsn; Bobbie Berkowitz, Phd, Faan


Nurs Econ. 2012;30(5):268-274. 

In This Article


Primary care delivery is going through a major redesign to increase its capacity to deliver high-quality cost-effective care. How ever, the provision of such care is becoming challenging because of the lack of available primary care providers to meet the needs of a growing health care industry. The primary care physician workforce is expected to continue shrinking as fewer medical residents choose internal and family medicine specialties. By 2020, the United States will face a shortage of more than 45,000 primary care physicians (Kirch, 2012). Others predict that by 2025, physicians will not be delivering primary care to the general patient population (McKinlay, 2008); instead, primary care will be provided by non-physician providers including nurse practitioners (NPs).

For about 5 decades, NPs have been utilized to deliver primary care, traditionally in underserved areas or to vulnerable populations. However, over the years, this workforce has experienced a steady growth and has expanded its reach to provide primary care in diverse settings. For example, over the past 10 years, the District of Columbia experienced a 458% increase in the number of NPs (Pearson, 2012). The vast majority of NPs, about 65%, are employed in ambulatory or primary care (Health Resources and Services Administration, 2008), and they compose about 20% of the total primary care workforce (Robert Wood Johnson Foundation, 2011). The NP workforce is predicted to grow 130% between 2008 and 2025 (Auerbach, 2012). Thus, this workforce represents a substantial source of human capital to increase access to cost-effective primary care. The RAND Corporation estimated the state of Massachusetts could save between $4.2 and $8.4 billion over 10 years if NPs and physician assistants were permitted to practice primary care to the fullest extent of their training (RAND Health, 2009).

In primary care settings, the quality of care NPs provide yields patient outcomes that are equivalent to those of physicians (Horrocks, Anderson, & Salisbury, 2002). This result has been reported consistently across studies (Newhouse et al., 2011). Many disciplines, including physicians, recognize NPs are capable of providing effective and safe care to patients with chronic diseases and managing many conditions in primary care settings (American Medical Association, 2009). Moreover, there are additional benefits associated with the care delivered by NPs. For example, NPs are better at communicating with patients and offering advice about self-managing their chronic conditions (Horrocks et al., 2002). Also, patients have better outcomes when physicians partner with NPs to manage chronic conditions such as diabetes compared to patients treated only by a physician (Litaker et al., 2003). This demonstrates the value of NP care, whether provided alone or in conjunction with other providers, when addressing certain complex diseases.

An additional 32 million patients will have access to primary care with full implementation of the Patient Protection and Affordable Care Act (2010). It is unlikely the scarce supply of primary care physicians will be able to properly meet the demand and the health care needs of the nation. A robust NP workforce can absorb the future de mands for primary care. The Institute of Medicine (IOM, 2010) along with other national practice and policy organizations are calling for expansion of the primary care NP workforce. In this article, some of the challenges NPs face in primary care settings are discussed, and practice, policy, and research recommendations for better utilizing NPs in primary care to mediate the workforce shortages and meet the demand for care are provided.