Nurse Practitioner: The Solution to the Primary Care Shortage

When allowed to practice to their full ability, nurse practitioners could fill a huge void left by a shortage of primary care doctors.


Why is there a primary care provider shortage? With fewer young physicians choosing to enter family medicine, opting for higher-paying, and glitzier specialty roles, the percentage of physicians in primary care is dropping. Established primary care physicians are getting older, and many are starting to consider retirement, further impacting the healthcare supply shortage.

  

According to the United Health Group’s Primary Care Report, nearly one-third of current primary care physicians will be retirement age by 2030. Add to that a graying and growing population, and the United States is left with an accelerating need for primary care services, but fewer physicians willing to provide them. By 2032, the Association of American Medical Colleges is predicting a shortage of more than 120,000 primary care physicians.

  

Nurse Practitioners and Primary Care Shortage

  

Time to panic? Not quite. Rather, now is the time to call on nurse practitioners — a proven group of health care providers who are ready, willing and more than able to step forward and provide the primary care that physicians are not.

  

Can Nurse Practitioners be Primary Care Providers?

  

Nurse practitioners, nurses with advanced clinical training, can perform most services that physicians provide, often at a lower cost. Complementing the work of primary care physicians, nurse practitioners can play an important role in expanding primary care capacity in hospitals facing shortages. Nearly 70% of the nation's 290,000 nurse practitioners deliver primary care, the use of nurse practitioners to address the growing health care provider shortage is already underway. Nurse practitioners already make up 25% of providers in rural areas, and increasingly play a role in nonrural primary care practices.

  

No Shortage of Cost-Effective Nurse Practitioners

  

An additional advantage of tapping nurse practitioners to fill anticipated primary care gaps is their reduced preparation time. It takes roughly 6 years to train an NP (4 years in a BSN program plus an additional 2 years in an MSN program), compared with double that for physicians. If used effectively, the growing NP population, combined with similar projected increases in the physician assistant population, could solve the primary care physician shortage.

  

Outdated Constraints Hinder Opportunity

  

So what’s stopping nurse practitioners from stepping in and providing care where their services are needed? In some states (such as Washington, Colorado, and Maine), nothing. In others, outdated, physician-centric laws and policies unnecessarily impede NPs’ ability to practice to their full extent.

  

Consider this observation made by the Institute of Medicine in 2011: “What nurse practitioners are able to do once they graduate varies widely for reasons that are related not to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work.”

  

In 20 states and the District of Columbia, nurse practitioners are legally allowed to practice to the full extent of their training. The remaining states, however, continue to require physician collaboration or supervision for NPs to legally perform specific tasks they are already trained to perform independently, such as prescribing controlled substances or ordering certain diagnostic tests.

  

By unnecessarily requiring physician involvement, state policies are hindering primary care NPs at a time when primary care physicians are disappearing. That’s why the Institute of Medicine as well as numerous other NP supporters are now saying it is time to do away with scope-of-practice barriers and increase NP autonomy.

  

As the Institute of Medicine puts it, nurse practitioners “have the opportunity to play a central role in transforming the health care system to create a more accessible, high-quality, and value-driven environment for patients. If the system is to capitalize on this opportunity, however, the constraints of outdated policies, regulations, and cultural barriers, including those related to the scope of practice, will have to be lifted.”