Family Nurse Practitioner Ann Lovegren Conley examines a patient on the
University of Southern Maine's Portland, Maine campus.
(AP Photo/Pat Wellenbach)
The already severe shortage of primary care physicians will likely reach critical the within ten years. Depending upon whose estimates are accepted, the doctor shortfall will be between 40,000 and 300,000 physicians. Because of the time it takes to train a doctor, the situation will likely persist for more than a generation.
This situation will pose multiple challenges to a U.S. health care system already reeling from criticism about cost and general quality of care. This shortage will be exacerbated by a lack of medical school and clinical opportunities, an increasing number of retirement age physicians, and an enlarging and aging patient census. America already has a much lower than average patient/physician ratio. While the average number of doctors in similar countries is 3.4 per thousand patients, the U.S. has licensed only 2.4 physicians for the same patient load.
One possible pathway through the shortage may be two relatively new categories of providers Physician Assistants and Nurse Practitioners. Both the P.A. and N.P. career tracks grew out of the military combat training experiences following the Viet Nam War.
The first P.A. program at Duke University graduated its initial students in 1965 in an effort to expand supply for a perceived shortage of doctors at that time. At about the same time a similar program for N.P.s kicked off at the University of Colorado for the same reason.
While there are training differences between the two groups, many of the job functions overlap. In general, P.A.s and N.P.s are qualified to perform roughly 80 percent of the functions required of a primary care doctor. Physician Assistants were originally allowed licensure with a BA only. Nurse Practitioners have specialized advanced training beyond that required of line Registered Nurses. It is still possible to become an RN without earning a Bachelor’s degree, but this is becoming rarer.
The training philosophies of the two disciplines differ. P.A.s are basically trained from the medical school model. N.P.s are more likely trained inside a School of Nursing. Much of the coursework required for either license is very similar. Nurse Practitioners are allowed to practice independently in some states, but both N.P.s and P.A.s more commonly operate under the direct supervision of a physician.
As each discipline has maturity and training protocols have developed, both are slowly transforming into Master’s Degree level programs or even higher. Both P.A.s and N.P.s are required to have passed local and national licensing tests and each must re-qualify with continuing education and re-testing every six years.
Both P.A.s and N.P.s have prescribing authority, perform physical exams, order and interpret lab results, diagnose illness, and treat patients. A big argument for the expansion of these programs during a time of looming shortages is that P.A.s and N.P.s can be trained in a much shorter time frame than fully certified M.D. or D.O. without any apparent dilution in quality of care. Some studies even show that N.P.s and P.A.s perform some tasks at a higher level than the supervising doctors.
The net effect from the addition of both categories of new professionals is to extend the patient access capabilities for existing physicians. Many P.A.s and N.P.s work in physician shortage areas. Both groups earn good livings; but normally at about half the salary of what a typical primary care doctor earns.
By 2020, the number of available P.A.s will have expanded from today’s 75,000 to around 140,000. Projections for Nurse Practitioner numbers are harder to come by. There are an estimated 140,000 licensed Nurse Practitioners today. The limiting factor in training additional N.P.s may be the number of doctoral level trainers available and the level of pay that these trainers can expect for their work.
The existence of these two, fairly new, career paths make the looming, primary physician shortage challenge appear more manageable than it otherwise might have been.
Other shortfalls in nurses and other technical personnel may be harder to solve because of a potential lack of teachers. Pay for experienced professionals in these areas may be in excess of what has traditionally paid to teachers in technical programs.
Next: How local community colleges and technical schools are attempting to train ancillary professionals.
As America searches for solutions leading to a reformation of its own health care system, knowing the successes and shortcomings of health care regimes in other developed nations will be essential in negotiating the most palatable and efficient design for all concerned. This series attempts to connect the dots and explode the talking points in hopes that the folks who actually have a vote might come to a conclusion.
Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” Portner is also the proprietor of The Assignment Desk, LLC and provides writers, editors, and photographers for numerous kinds of contract projects from proposals and speeches to public relations and journalism. Reach him at alanportner@gmail.com.
Nurse Practitioner Association website
Physician Assistant and Nurse Practitioner Workforce Trends
Physician Assistant Association website
Comments
school employees do not make million dollar salaries from the school. if they make that much, it is due to extremely hard work resulting in things such as grant money and/or research awards. plus, making school more affordable would not increase the number of providers in the country. schools are still limited by the number of students they can reasonably accommodate and you should want it to remain so. you say, "you want to see a doctor" and you say that because of the reputation a physician has from making it through a difficult program. take away the competition, you will take away the value.
beyond that, this article completely neglects one other profession capable of bridging the gap: pharmacists. doctors of pharmacy have advanced dramatically in the last 5-10 years and are already proving effective in collaborative settings at reducing hospitalizations and costs.
"school employees do not make million dollar salaries from the school"
Maybe you should do some research into what some of these administrators and deans and the such make yearly before you continue. Also, it is the big pharma that is killing people left and right without adequate accountability. Most of their so called drugs have more side effects than help.
"doctors of pharmacy have advanced dramatically in the last 5-10 years and are already proving effective in collaborative settings at reducing hospitalizations and costs."
Lies, they cause as much hospitalization from the drugs they create to put band-aids on the symptoms instead of cures. People here go to other countries to get cheaper drugs as well, most on fixed incomes cant afford the drugs they used to be able to. Your information wreaks of salespitch.
Also, from our food industry that keeps putting chemicals in our food causing alot of the problems, and then here comes big pharma to the rescue with drugs that mask the symptoms, there are no cures, the cures are prevention and they know this. Maybe they are in cahoots to provide the disease and the medicine to ease the symptoms...there is no money in cures, theres big money having slaves keep buying for the rest of their lives. Also, did you not read the reports about the vaccines that had HIV, swineflu, birdflu in them, mistake? Yea Ill buy that when hell freezes over. Look at the lucrative contract they will have with the governemnt for swineflu vaccines that are riddled with issues, and the fact swineflu is bogus on its face since more people in 1976 died from the vaccine than the flu. Come back when you grow up. Its a racket.
"schools are still limited by the number of students they can reasonably accommodate"
So smart people that dont have the 100k to be in school are excuded based on the number of people? That makes no sense. If education was as important as they make it sound, it should be available to all those that qualify, alot of rich kids done qualify, but daddy's rich and well connected.
"so. you say, "you want to see a doctor" and you say that because of the reputation a physician "
Nope, because he knows more about what he is doing than some nurse. But, most doctors hands are tied by bureaucrats and insurance companies, they arent allowed to be doctors, maybe thats another reason for the shortage.
As for the pharmacists, they do serve a purpose and are deserving of some kudos, but the pharma companies bribe doctors to push their drugs and punish those that do not. Alot of these companies abuse us for gain. This is directed at the institutions and companies, not the little guys...doctors and pharmacists, the schooling is a major part. We are bringing doctors from other countries because of numerous reasons, go look at the cost of schooling in these countries they come from, like India. And they are still good doctors.
Hmmm, seems to me that most "international' doctors are people we train here in the US, and they stay in the US because they can make more money than in their country. I think we are not only seeing an overall shortage of MDs, but a true shortage of US citizen MDs. Some reasons may be no access to money because they are not minorities, no access to the educational facility because it is already full with international students, and because the high cost of malpractice insurance and limited payouts. My father said if he had it to do all over again, he would be a PA.
And BTW, my father is one of those 'international' MDs
Most international physicians go to medical schools in their home countries and take their residencies and fellowships in the U.S. This has to do with the way that residencies are funded. Congress funds about 23,000 new residencies a year, but U.S. medical schools only produce about 15-16 thousand graduates each year. Medical schools have pledged to expand by 30 percent by 2016, but even this will not meet the need probably.
i'm going to medical school right now and i definitely don't have "rich daddy", rsbl. my parents didn't pay a dime for me, but i qualified for student loans. the majority of my classmates are in the same situation as me. i'm incredibly offended by your words.
a doctor of pharmacy IS a pharmacist. all you have to do is google "pharmacist reduce hospitalizations" to know that my words aren't "LIES".
RSBL apparently needs a job if he/she has so much time to post here. Doctor? Certainly not a pharmacist or NURSE, oh forbid! Take your head out of your, er, self-dug cave, and look at real health care. If you are a "doctor" or plan to be, better learn to be a team player.
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