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By Sylvia Hastanan, founder and CEO of Greater Good Health
For more than 20 years, we’ve been facing a widespread shortage of primary care physicians – a problem that is only going to continue to worsen with time. Today, there is a shortage of about 13,800 primary care physicians nationwide, with this number expected to increase more than eight times over, reaching 121,300 by 2030.
Reasons for the shortage are manifold: there are fewer medical students choosing to go into the primary care field, while current primary care physicians are retiring at high rates. Plus, the U.S. population is aging, with baby boomers surging into Medicare age.
Unsurprisingly, this is hindering access to proper care for all patients, making it difficult for people to see a primary care provider when needed. Even worse, this lack of access is exacerbating existing disparities in healthcare.
And while nurse practitioners (NPs) have been a critical piece of the healthcare system to-date, there is now an immense opportunity for the profession in helping curb this shortage and provide our communities more access to healthcare. As advanced registered nurses obtain graduate education and board certification, they are choosing to go into primary care more than physicians. In fact, 78% of NPs practice primary care, as opposed to only 33% of physicians. Additionally, there are three times more NPs graduating in primary care today than physicians.
Like physicians, NPs can assess, code, diagnose, prescribe medication and much more. However, historically, NPs have only been allowed to practice with oversight from physicians.
This is rapidly changing. State legislation is broadening the scope of practice for NPs, allowing them to practice independently. In some states, including Arizona, Washington, Oregon and more, NPs already have full practice authority. In others, such as California, they’re expected to see changes in the coming years. With full practice independence, NPs can panel their own patients, rather than just “extend” a physician’s practice.
It’s undeniable that these legislative changes will improve access to healthcare for patients as more NPs become primary care providers. This means shorter wait times for appointments and additional options when choosing a provider and more.
The Rise of Value-based Care
NPs are nurses by training, which means they are focused on whole-person care from the beginning. Using a holistic approach, nurses are trained to consider not just the patient’s condition, but how that patient will live with that condition. For example, nursing students are taught to think about how a patient will adhere to their medication at home in addition to how to manage a disease with a specific drug.
This focus on whole-person care aligns with the recent rise of value-based care – the idea that patient outcomes should be valued rather than how many times a patient is seen. In a value-based care payment model, providers are reimbursed based on the health status of their patients.
With the healthcare industry increasingly adopting the value-based model, NPs are in an even more primed position to thrive as primary care providers.
Improved Access for All
With legislation continuing to evolve and value-based care becoming more prominent, it’s clear that NPs will help solve the primary care crisis. In addition to shorter wait times and additional providers to choose from, this means improved access to proper healthcare for all – including patients in underserved and rural locations.
In rural communities, the primary care physician shortage is at its worst, with most providers currently choosing to practice in urban metropolitan cities. Additionally, for many people living in rural communities, the issue of access is further intensified by social determinants like language, transportation, and financial barriers. The growing shortage of primary care physicians will further widen the health disparities we already see today.
Compared to physicians, NPs are more likely to practice in rural communities. According to the American Association of Nurse Practitioners (AANP), 18% of NPs are practicing in communities of fewer than 25,000 residents.
As more NPs open primary care practices in underserved and rural communities in the coming years, it will finally become easier for patients in those areas to receive proper care.
Today, it’s common for primary care practices to operate with a handful of physicians and one NP. In the future, we can expect to see that ratio flip – with empowered NPs and optimized physicians.
To prepare for that future, it’s critical that we support and empower NPs as they assume their roles as leaders in primary care. There will need to be mass education and advocacy campaigns to explain that NPs provide the same level of – or, in some cases, better – care as their physician peers. Additionally, insurance companies must start partnering with NPs and NP groups to panel patients to solve for this dire primary care shortage problem.
With Nurse Practitioners at the forefront of primary care, the future is brighter than ever before.
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