Primary Care Shortage: NPs and PAs May Not Be the Answer

Troy Brown

August 16, 2013

Relying on nurse practitioners (NPs) and physician assistants (PAs) to relieve the primary care shortage may not be the answer, as many NPs and PAs work outside of primary care, according to a Graham Center Policy One-Pager published in the August 15 issue of American Family Physician.

Stephen M. Petterson, PhD, from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and colleagues analyzed data from the National Provider Identifier file, which identifies the locations of NP and PA clinics and identifies physicians who work in the same location. NPs and PAs practicing in clinics without a primary care physician are assumed to be practicing primary care.

Those data show that only about half of NPs (52.4%) and PAs (43.2%) work in primary care, with the others choosing subspecialty areas.

"We know family physicians are all primary care physicians. We currently lack comprehensive national nurse practitioner workforce data and, until recently, we've had limited access to physician assistant workforce data," Andrew Bazemore, MD, MPH, director of the Robert Graham Center, said in a press release from the American Academy of Family Physicians.

"However, using National Provider Identifiers and estimates that are based on whether nurse practitioners and physician assistants work in the same location as physicians, we are finding that the trends towards subspecialization we see among physicians are also occurring in the nurse practitioner and physician assistant communities. This finding corroborates recent federal studies of nurse practitioners and those of physician assistant organizations," Dr. Bazemore explained.

NPs and PAs may be influenced by similar factors that encourage physicians to choose subspecialties, such as student debt and income gap disparities. Strategies used to encourage physicians to choose primary care, including training in rural and underserved areas and student debt reduction, may also be effective with NPs and PAs, but more research is needed to know for sure, the authors write.

"Relying on NPs and PAs to solve the problem of a growing shortage of primary care physicians may not be an option, and policy makers should not abandon policy solutions designed to increase the number of primary care physicians, NPs, and PAs," the authors write.

The authors have disclosed no relevant financial relationships.

Am Family Physician. 2013;88:230. Full text

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