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DiversityNursing Blog

Doctor shortage may not be as bad as feared, study says

Posted by Alycia Sullivan

Wed, Nov 13, 2013 @ 10:14 AM

Kelly Kennedy, USA TODAY

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New roles for nurse practitioners and physician assistants may cut a predicted shortage of physicians by about 50%, according to a new study released Monday.

The surge in new patients covered by health insurance that will be sparked by the Affordable Care Act has led to predictions that there will be a shortage of 45,000 primary care physicians by 2025, about 20% less than the predicted demand, said David Auerbach, a policy researcher at the Rand Corp., a non-profit policy think tank that conducted the study published Monday in the journal Health Affairs.

Those studies, Auerbach said, were based on the assumption that health care practices would not change how they operate and ignore provisions in the 2010 law that allow the creation of nurse-managed health centers and medical homes that could relieve physicians of some of their caseload. Technology improvements, also spurred by the law, could also relieve part of the shortage, he said.

"The story has been, 'There's a looming physician shortage, and the Affordable Care Act's going to make it worse, so what are we going to do?" Auerbach said. "But even policy-makers looking at those numbers don't realize they're coming from a static, unchanging way of how we deliver care."

A surplus of 34,000 nurse practitioners, about 48% above demand, and 4,000 surplus physician assistants will help relieve the doctor shortage, Auerbach and his research team found.

Two elements are critical to relieving the shortage, Auerbach said:

• Medical homes. A group of people working together to provide care. A physician, physician assistant or nurse practitioner leads the team of doctors, nurses, pharmacists, nutritionists and social workers using electronic health records and care coordination. Each team can care for larger numbers of patients than a doctor could on his or her own.

• Nurse-managed health centers. These are centers managed by nurses consisting of nurse practitioners. Usually, they are affiliated with academic medical centers, and they often provide specialty care to low-income populations.

"I think these changes can matter quite a lot," Auerbach said. "It's sort of a given: If you use nurse-managed health centers, you're not using a lot of doctors. But patient-centered medical homes, I guess we really didn't know the outcome."

So far, Auerbach said, researchers have seen positive examples of how the changes can work, but they need more analysis.

The new health law promotes these models because they save money, and has provided up to $50 million in direct grants to support nurse-managed health centers. And there are pilot programs for Medicare and Medicaid patient-centered medical homes. The authors said states may need to "liberalize" scope-of-practice laws for nurse practitioners and physician assistants to fill those roles, as well as supply more nurses and aides.

The American Association of Nurse Practitioners is launching a new advertising campaign to try to push for those opportunities, as well as to help people understand what nurse practitioners do.

According to the American Academy of Physician Assistants, 60 new physician assistant programs were waiting for accreditation as of May, and they expect 10,000 new physician assistants by 2020.

Source: USA Today

Topics: physician assistant, ACA, doctor shortage, healthcare, nurse, nurse practitioner

Should you hire a Nurse Practitioner or Physician Assistant before a physician?

Posted by Alycia Sullivan

Fri, May 17, 2013 @ 12:46 PM

The U.S. is currently seeing a physician shortage that will only continue to rise and affect medical practices all over the country. By 2020, the American Association of Medical Colleges (AAMC) estimates there will be a shortage of more than 90,000 physicians, and that number will grow to 130,000 by 2025.

To solve this problem, many healthcare providers are turning to Nurse Practitioners (NPs) and Physician Assistants (PAs). While many people believe NPs and PAs are unable care for patients as well as physicians, studies have found that to be untrue.  Victoria Garment, editor at website that presents reviews and ratings of healthcare technology-- explains:

“Decades of studies have demonstrated that, when permitted to practice to the full extent of their training, NPs and PAs can perform a majority of the tasks that physicians do while providing the same quality of care.”

These tasks can include performing physical exams, diagnosing and treating conditions such as diabetes or high blood pressure, writing prescriptions, order diagnostic tests and more. Additionally, “while PAs cannot practice independently of physicians, there are approximately 250 practices across the U.S. that are run solely by NPs,” Garment said.

Another benefit of hiring NPs and PAs is the significant cost savings:

  • Reduced salary expenses - The average base salary of a physician is more than double that of NPs and PAs.
  • Lower overhead costs - Studies show PAs require lower overhead costs than physicians by department, patient demographics and medical care resource use, resulting in a $30,000 boost to the bottom line.
  • Lower costs of care - The costs of NP-managed practices have been found to be 23 percent below physician-managed practices. This can lead to statewide savings of $4.2-$8.4 billion.
  • Higher patient volumes - Another study found that adding an NP to a practice can double patient numbers and boost yearly revenue by $1.65 million per 100,000 enrollees.
  • Reduced insurance and liability costs - Not only is a PA’s liability risk cost one-third of a physician’s, but NPs also have much lower rates of malpractice claims and lower costs per claim.

What’s more, patients often report having an equal or even better experience with an NP or PA compared to a physician. A survey by Medscape found that 80 percent of patients felt NPs “always” listened while carefully compared to 50 percent of physician patients. Similarly, the Kaiser Permanente Center for Health Research released a report that said PA patients ranked their satisfaction levels between 89 to 96 percent for the quality of care they received in the areas of interpersonal care, confidence in the provider and understanding of patient problems.

With all the benefits that NPs and PAs bring, they can be a great addition or alternative to any medical practice, especially those experiencing physician shortages.

To read the full report on The Profitable Practice blog, visit: “Nurse Practitioners and Physician Assistants: Why You Should Hire One (or the Other).”

Topics: physician, physician assistant, AAMC, costs, liability, nurse practitioner

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