Why nurse practitioners and physician assistants will not solve the primary care shortage

I often get asked why mid-level providers, like nurse practitioners and physicians, can’t “take-over” primary care and solve the generalist physician shortage.

I’m going to concede the point about the variability in training, because the discussion invariably degenerates into a nurse versus physician shouting match whenever this issue is raised.

Let’s assume, for the sake of argument, that mid-levels provide primary care equal to that of physicians.

Liberal policy wonk Ezra Klein asks, “rather than drawing from the same pool that produces surgeons, why not draw from the pool that produces nurses?”

The simple answer is that there are not enough of them.

Bob Doherty wrote that, according to the Association of American Medical Colleges, there will be a shortage of 46,000 primary care doctors by 2025, and even accounting for the growth of PAs and NPs, “their numbers will not be sufficient to eliminate the emerging physician shortage.”

I’ve also previously alluded to the fact that mid-levels are not immune to the vast incentives favoring practicing in a specialty environment. As Val Jones reported, when nurses were asked why more are not entering generalist practice, the reply was blunt: “We’re not suckers.”

Already, 42 percent of mid-level providers practice in specialty fields, and I fully expect this number to rise if the primary care environment continues to deteriorate, especially when contrasted to the salary and lifestyle offered to specialists.

So to those who think that nurses and other mid-level providers can solve our primary care woes, I don’t see it happening.

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  • Anonymous

    I don’t see it happening either. Most of the midlevels are just fitting themselves into a specialty practice anyway. It drives me crazy when I refer to a specialist and the patient ends up seeing a midlevel. That’s fine if the patient is just making a visit in preparation for a screening colonoscopy. It’s still another matter if I’m trying to tease out the subtleties of someone’s chronic diarrhea and abdominal pain, trying to figure out inflammatory colitis versus, etc., etc….

  • drjonslater

    Good thoughts, but how about using the mid levels to do things that primary care docs don’t really need to do? For example, bp checks, refilling prescriptions, chronic care monitoring? That would free up the primary care doc for diagnosis and care planning.

  • Anonymous

    To “anonymous”, refer your patient to someone else. I agree with dr…..; they could make a difference in a primary care setting, performing many perfunctory duties. In large medical homes the use of these professionals could allow expansion of the practices and more access to healthcare.

  • Anonymous

    “…..To “anonymous”, refer your patient to someone else…..”

    That’s precisely what I do.

  • Anonymous

    Kevin MD you don’t need to assume that other mid-level providers, like NP’s, give equal care to physicians…because it’s been proven that the outcomes are the same. Furthermore, it’s been provern through evidence based means, RCT’s, that the care given in the primary care setting by the APN is equal to or better than the physician equivalent. So, quit “assuming” because you don’t have to….Look it up, it’s in Cochrane database 2006!

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