The Solution to a Shortage of Primary Care Physicians
March 24, 2014
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According to the Association of American Medical Colleges, by 2020 the U.S. faces a 45,000 shortage of primary care physicians (PCP). Driven by the rapid increase in the number of older adults and the expansion of health insurance coverage, the consequences of such a shortage could be catastrophic. Compounding the problem is an American healthcare system already challenged by massive changes initiated through the Affordable Care Act (ACA).
In response, medical schools are enrolling more students and expanding primary care training, but many students find there are limited residency opportunities, and end up completing their medical degrees overseas. Intensifying the problem, family doctors are aging right alongside their baby boomer patients, and many are retiring early.
One possible solution to the shortage is to replace a single overworked doctor with a team that includes nurse practitioners (NPs) in expanded roles.
Can Nurse Practitioners Fill the Gap?
Along with physician assistants, nurse practitioners are a tremendous resource that may help alleviate the crisis. Nurse practitioners are RNs with an advanced degree and specialized training. Some branch into certain fields (like gerontology or pediatrics) while others work in general practice settings.
Nurse practitioner advocacy organizations, such as the American Association of Nurse Practitioners, recognize the need to respond to the crisis early and are calling for NPs to be key participants in both developing and implementing solutions. One approach is to increase the use of team-centered strategies in the provision of primary care. While physicians care for patients with more serious problems, NPs can focus on patients with more minor complaints.
Overcoming Barriers and Challenges
Significant barriers exist that, if left unaddressed, will severely limit the role NPs can play in alleviating the impact of the shortage. For example, primary care physicians resist sharing the time-honored role of family doctor with practitioners who are not doctors and who haven't put in the same investment of time and money.
Provisions within the ACA attempt to bolster the nation's teetering primary care network by authorizing a 10 percent bonus to PCPs caring for patients who receive Medicare, funding additional training for NPs, doctors and physician assistants, and increasing the number of nurse training clinics. For areas already suffering a shortage, it also increases patient access to community health centers. A major challenge to these solutions is a gridlocked Congress holding back funding while trying to balance mountains of debt.
In 2013, the National Institute for Healthcare Reform submitted a research brief discussing how NPs can be better adapted toward meeting the challenges brought on by the shortage of primary care physicians. It calls on policy makers to make provision for nurses to practice at the "full extent of their education and training," and explains the need to improve the nation's nurse education programs to make for seamless transitions for nurse advancement. It also calls on NPs to become "full partners…in redesigning health care in the United States."
With such high profile support for NPs to help ease the load on primary care physicians, and with nursing degrees expected to be in much higher demand very soon, it's an exciting time to be making the move to a nursing career.
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