Nurse practitioners will not solve the primary care shortage

With health reform possibly passing within the next few months, attention now turns to the primary care doctor shortage.

Regular readers of this blog know that there are not enough primary care doctors currently; it’s frightening to think what would happen if an additional 40+ million newly insured patients start looking for care.

A recent piece from Newsweek nicely encapsulates the problem. It’s a good piece, elucidating the myriad of reasons why new medical students shy away from the field:

The close relationships that general practitioners once had with patients drew many idealistic students into the field. Now recruiters face an extra-tough sell: they have to convince bright young would-be docs to pursue a career that won’t pay very well and won’t be as emotionally fulfilling as it once was.

There are some who believe that primary care offices don’t necessarily need to be staffed by physicians; nurse practitioners and physician assistants can help reduce the shortages. And by the way, replacing doctors would be a great way to cut costs.

The problem is both nurse practitioners and physician assistants aren’t immune to the financial incentives swaying doctors away from primary care:

The problem with taking this approach nationwide is that nurses and PAs are subject to the same economic forces that drive medical students. Almost half of current nurse practitioners and physician assistants work in specialty practices, where the money is. Then there’s the fact that the country already has a nursing shortage. How are nurses going to replace doctors if there aren’t enough nurses to begin with?

Spending more money on primary care — and according to the American Academy of Family Physicians, we’re talking at least 25% more — is the best way to get the attention of not only medical students,  but also aspiring primary care nurse practitioners and physician assistants.

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