Expanding the role of nurse practitioners and physician assistants could help eliminate the anticipated shortage of primary care physicians (PCPs) over the next decade, according to a new RAND Corporation study.
By using new models of healthcare that depend more on non-physicians, such as patient-centered medical homes (PCMHs) and nurse-managed health centers, more than 50 percent of the expected shortage predicted to hit the United States over the next decade could be eliminated, according to findings published in the November edition of the journal Health Affairs. Forecasts suggest that as more Americans seek health services once they become newly insured under the Affordable Care Act (ACA), physician shortages could worsen, and reach as high as 45,000 by 2025. Those forecasts do not account for changes in how primary care is delivered, however.
PCMHs typically use a team-based approach that incorporates physicians, advance practice nurses (APNs), physician assistants, pharmacists, nutritionists and other health professionals, and account for about 15 percent of primary care nationally.
Nurse-managed health centers provide a full range of primary care and some specialty services. They are managed and operated by nurses, with nurse practitioners (NPs) functioning as the primary care providers. They account for only 0.5 percent of primary care and typically are affiliated with an academic health center.
According to the report:
- If PCMHs expand to deliver nearly half of primary care, the nation’s expected physician shortage would fall by 25 percent.
- If nurse-managed health centers expand to account for 5 percent of primary care, the doctor shortage would fall by another 25 percent.
These growth rates are plausible, researchers say, given that PCMHs have been growing rapidly and the ACA provides up to $50 million to support nurse-managed health centers, researchers say.
But there also obstacles to such growth. State laws may need to be changed to widen the scope of practice for both NPs and physician assistants so they can fill a wider role in primary care.
In addition, there is a need for medical assistants, licensed practical nurses and aides to perform key functions in the new care models, as well as new payment approaches that reward providers for moving to efficient and effective modes of care.
Source: RAND Corporation, November 4, 2013
Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care, a 45-minute webinar on November 20, 2013 webinar at 1:30 pm Eastern will examine the trend toward medical neighborhoods and effective strategies for building out the neighborhood. Terry McGeeney, MD, MBA, director of BDC Advisors, will share his expertise in developing these systems of care.