The United States faces a serious shortage of physicians. In 2016, this shortage was estimated to be around 20,000 and the shortfall is projected to grow to 120,000 by 2030 according to the Association of American Medical Colleges.
One promising solution to address this shortfall would be to give other healthcare practitioners, namely physician assistants (PAs) and nurses greater authority to treat patients. Scope-of-practice laws restrict the ability of these practitioners to administer medicine, often by requiring little more than a doctor’s signature to proceed with a given treatment.
Sara Heath, writing for Patient Engagement HIT, points out the role non-physician clinicians can play in addressing this shortage:
A June 2018 analysis from MGMA showed that APRNs and PAs are in higher demand because of the physician shortage. Because more organizations want to hire non-physician clinicians to fill care gaps, nurses have seen average annual salary increases from $48k in 2015 to $57k in 2018.
The job market for PAs has grown by 53 percent, and the average salary for a PA has grown in the past five years to $107,718 in 2018.
Nurse practitioners and their colleagues can bring significant value to organizations embracing team-based care models, said Christy Dempsey, Chief Nursing Officer at Press Ganey.
“We have seen good outcomes when nurse practitioners are able to be autonomous,” she said in a previous interview. “There is also broad understanding that when we are educated and trained as nurses, we understand the value of an interprofessional team and that none of us can do this by ourselves. Because interprofessional teamwork it is so ingrained in nurses and then therefore nurse practitioners, autonomy does not mean that we won’t work without interprofessional colleagues to take care of patients.”
Indeed, there is little evidence to support the proposition that a physician (or their sign-off) is necessary to perform a number of medical procedures, creating an opportunity for PAs and nurses to fill that gap.
Of course, some physicians are skeptical.
A 2013 essay from the American Academy of Family Physicians’ president-elect at the time, Reid Blackwelder, MD, asserted that physician and NP roles are not interchangeable. Because of variable and shorter training periods, NPs may not be ideal candidates for filling care access gaps, Blackwelder wrote.
“There is no question that nurse practitioners, physician assistants and others are each vital parts of our health care team. But they are not physicians,” he said. “Although some tasks and services can be shared, the roles each of us play are not interchangeable. The medical expertise of primary care physicians must be a part of the team-based care patients need and deserve.”
Nobody is seriously arguing that physicians can be fully replaced. This argument is a red herring used to justify policies that enrich physicians at the expense of both patients and other clinicians.
For more on the expanded role nurses and PAs can play in the healthcare system, read this Hamilton Project report by E. Kathleen Adams and Sara Markowitz.
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