Impending Doctor Shortage May Lead to New Options for Healthcare
The Association of the American Medical Association estimates that, because the new federal healthcare law will bring an influx of as many as 32 million new patients into medical offices across the country, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, mostly in primary care settings. To ease the transition for many patients, many states are considering expanding the roles of physician extenders, particularly nurse practitioners and physician assistants.
Twenty-eight states are considering laws that will expand the authority of nurse practitioners (NP). These are registered nurses with advanced degrees, usually a master’s or a doctoral degree, and have advanced training in the diagnosis and management of many medical conditions. NP’s are licensed by state nursing boards and also a national board, such as the American Academy of Nurse Practitioners. They may also have specialty certifications, such as in pediatric care or oncology.
Each state has a different law on the scope of practice for nurse practitioners. Most work under the supervision of a physician and can prescribe most medications, with the exception of controlled substances. Medicare reimburses for most care by an NP, however at a lower rate than medical doctors (85%). The exception is a nurse midwife, which is paid at the same rate as an obstetrician/gynecologist under the new healthcare reform package.
Another option is to expand the role of the physician assistant (PA). The role was created in the 1960’s to address the primary care physician shortage due to the war in Vietnam. PA’s are also highly trained healthcare providers who have earned a master’s of medical or physician assistant degree, have attended an accredited program and have passed a national board certification exam. They are licensed to perform medical services under physician supervision.
The supervising physician determines the PA’s scope of practice. In general, as part of their responsibilities, PA’s can conduct physical exams, order and interpret tests, and diagnose and treat illnesses. They can also write prescriptions.
While some in the medical profession are protesting the use of physician extenders to meet the expanding health care needs of Americans, both Nurse Practitioners and Physician Assistants provide quality healthcare and are an excellent adjunct to a growing medical practice.