What the Physician Shortage Means for Nurse Practitioners

A study from the Association of American Medical Colleges (AAMC) reports that the nation’s population will grow 10 percent between 2013 and 2025 — with a 45 percent increase for those ages 65 and over. And according to a study from the Health Resources and Services Administration (HRSA), population growth and aging will account for 81 percent of the increased demand for primary care services between 2010 and 2020; the remainder is due to the expansion in health insurance coverage ushered in by the Affordable Care Act (ACA).

As the physician shortage intensifies, other healthcare professionals are being called on to assist them with patient care. A rise in the number of nurse practitioners presents an exciting opportunity for this profession to assume more responsibility in providing primary care.

The Physician Shortage

Figures

The AAMC study projects a shortage of 46,100 to 90,400 physicians by 2025, including 12,500 to 31,100 primary care physicians (PCPs) and 28,200 to 63,700 surgeons and other specialists. PCPs include doctors who are board-certified in family medicine, geriatric medicine, internal medicine, and pediatrics. The variation in these figures reflects a number of supply-and-demand scenarios, which take into account changing demographics, health insurance coverage and other factors.

A significant factor is the age of the current physician workforce. There were 767,100 practicing physicians under the age of 75 in 2013, the AAMC found. But those between age 65 and 75 made up 10 percent of the active workforce, and those between age 55 and 64 made up 26 percent of the active workforce. “It is likely that up to a third or more of all physicians could retire in the next decade,” the report said.

Meanwhile, the HRSA study notes that the projected supply of PCPs from 2010 to 2020 is considerably less than the projected demand, as measured by full-time equivalents (FTEs):

• The number of PCPs is expected to increase to 220,800 FTEs in 2020 from 205,000 in 2010, an 8 percent increase.
• Total demand for PCPs is expected to grow to 241,200 FTEs in 2020 from 212,500 in 2010, a 14 percent increase.

If there are no changes to the system for delivering primary care, HRSA projects a shortage of 20,400 PCPs in 2020.

Potential Solutions

According to the AAMC, lifting the cap on federally funded residency training positions would help, and some lawmakers have responded by proposing legislation. The goal would be to gain federal support to add at least 3,000 more slots for physicians in training each year. The AAMC and HRSA studies include nurse practitioners as a significant part of the solution to the physician shortage, assuming continued growth in the number of nurse practitioners (NPs) and physician assistants (PAs). “Increased use of NPs and PAs could somewhat alleviate the projected primary care physician shortage if they are effectively integrated into the health care delivery system,” the HRSA said. Should that happen, the shortage of 20,400 PCPs could drop to only 6,400.

In order to change the way primary care services are delivered, healthcare providers need to focus on a patient-centered team approach that stresses prevention and incorporates health information technology. Both the federal government and private insurance companies are offering financial incentives to practitioners for quality, affordable patient care.

Demand for Nurse Practitioners

Nurse practitioners have emerged as an attractive, practical solution for the physician shortage. The Atlanta Journal-Constitution reports that research shows NPs provide care equal to or better than physicians at a lower cost and calls nurse practitioners “the future of health care.” The AAMC study points to how states are more willing to expand the legal scope of practice for nurse practitioners, which will help respond to the pressure to control rising medical costs.

Consequently, the demand for nurse practitioners has skyrocketed. This trend is expected to continue, in large part due to the expanded scope of practice, the physician shortage and health insurance coverage under the ACA. Forbes notes other factors, such as new models of healthcare delivery that place nurse practitioners in the role of a primary care provider, and the retailers and grocers that continue to open clinics often led by a nurse practitioner.

Current Supply and Future Projections

According to the American Association of Nurse Practitioners (AANP), there are more than 205,000 nurse practitioners licensed in the United States. Approximately 15,000 new nurse practitioners graduated in 2012-2013.

Based on the rate of new nurse practitioners graduating each year and entering patient care, the AAMC study estimates that the FTE supply of nurse practitioners will grow by 83 percent between 2013 and 2025, to 242,800 from 133,000. Nurse practitioners in primary care have a projected growth rate of 93 percent — higher than other registered nurses with graduate-level degrees such as certified registered nurse anesthetists (38 percent) and certified nurse midwives (24 percent).

Other figures echo the current growth trend for nurse practitioners. In a 2014 study from the physician staffing firm Merritt Hawkins, nurse practitioners and physician assistants together occupied the fifth spot of most requested recruiting assignments. Three years before the study, neither position could be found in the top 20. Demand grew by 320 percent.

Ongoing Education Standards for Nurses

The 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, called for higher levels of education for nurses. Not only did it recommend that 80 percent of nurses hold a bachelor’s degree by 2020, it added that schools should encourage at least 10 percent of their baccalaureate graduates to enter a master’s or doctoral program within five years.

Citing healthcare reform and increased patient needs, the report pointed to how nurses should take on leadership roles and practice to their fullest extent. A priority was placed on nurse practitioners to meet the increased demand for primary care. Higher degrees and additional training would help promote nursing leaders, provide a greater scope of practice and advance healthcare.

Nurse practitioners and others are now in a better position to ease the burden of the physician shortage and assume more primary care roles, in turn creating more opportunities and demand for nurse practitioners.

Nursing at Rivier

Current nurses can make a greater difference in healthcare by furthering their education. More nurse practitioners are needed, and the online M.S. Nursing: Family Nurse Practitioner degree program from Rivier University can help nurses become leaders in primary care. Nurses can earn a master’s degree and pursue an in-demand career in the healthcare system.