Much of the United States is facing a serious shortage of healthcare providers. The health provider shortfall is especially acute for primary care professionals, and especially in rural areas. This shortage is made especially acute by our aging population. The Association of Academic Medical Colleges predicts a US shortage of 159,000 physicians by 2025.
This shortage of physicians has been partially covered by large recent increases in the numbers of physician assistants and nurse practitioners. In 2018, there were 106,200 PA’s practicing in the United States. The number of US PAs is expected to grow rapidly by 37 percent between 2016 and 2016 (2). The number of US NPs was 179,650 in 2018, which is expected to increase by 35.5 percent between 2014 and 2024.
Considering the primary care shortages, PAs and NPs play an especially important role in this specialty. A 2018 survey of PAs reported that 61 percent work in physician offices, 26 percent in hospitals, 8 percent in outpatient care centers, 3 percent in colleges, and 2 percent at employment services. A survey of Nurse Practitioners in 2018 reported that 54 percent worked in physician offices, 28 percent in hospitals, 11 percent in outpatient care centers, 4 percent in offices other health care practitioners, and 3 percent in colleges.
PA’s and NP’s often play a major role in many health care treatment niches. For example, one study of 201,237 older patients with cancer reported that 31.5 percent were treated by nurse practitioners, 27.7 percent by hematology/oncology physicians, 24.7 percent by physician assistants, 10.9 percent by medical oncologists, 2.6 percent by gynecological oncologists, and 2.4 percent by hematologists.
What do consumers think of being served by physician assistants or nurse practitioners?
A survey of 2,053 representative US adults reported that, while most patients would prefer to be seen by a physician, a large majority (more than 2 to 1) preferred to be seen today by a PA or NP as opposed to waiting longer to see a physician.
Some people are concerned that physician assistants and nurse practitioners might not be able control complex medical problems like diabetes, with the understanding that it takes at least seven years of post-B.S. education for physicians (medical school and residency). On the other hand, PA’s can become qualified with just two years of post-B.S. education, and NPs can be qualified in only 2-to-3 years of graduate study.
Most of the research concerning competency of PAs and NPs versus traditional physicians is quite reassuring. For example, two studies have reported that diabetes were managed just as well by PAs and NPs as compared to physicians. A 2012-2013 Veterans Affair (VA) study reported that medical care for patients with complex diabetes was 6 to 7 percent lower for PAs or NPs as compared to physicians.
Over 20 studies have even reported that care given by physician assistants or nurse practitioners is superior to that of physicians or resident physicians. Published studies have reported that care given by PAs and/or NPs is superior to that of MDs/ DOs in terms of decreased length of hospital stay, improved nursing and physician satisfaction, higher rates of home discharge, decreased Emergency Department to Intensive Care Unit (ICU) time, decreased lab costs, decreased 14 day readmission rates, decreased care for heart failure patients, decreased surgical complications, and decreased operating times.
Other studies have reported that use of PAs and/or NPs versus physicians results in similar or improved patient care outcomes for many parameters, including reduced days in hospital/ICU/mechanical ventilation, reduced mortality rates, reduced readmission rates, reduced rates of infections, and reduced rates of stress ulcers.
In short, physician assistants and nurse practitioners can provide care as good as physicians, often at a much lower cost.