NPs and PAs Also Look to Specialty Practice

Although physician assistants (PAs) and nurse practitioners (NPs) are often cited as a potential solution to the primary care physician shortage, a new report shows that more PAs and NPs are looking to work outside of primary care.

Patients have already said in a Health Affairs study that they would be open to being treated by PAs or NPs. While half of Americans still prefer to have a physician as their primary care provider, they were willing to see NPs and PAs if it meant getting help sooner.

However, a Robert Graham Center for Policy Studies in Family Medicine and Primary Care study revealed that revealed that because of the trend for PAs and NPs to work outside of primary care, relying on them won’t avoid the need for policy solutions.

By reviewing the National Provider Identifier, researchers determined that, based on clinic locations and the physicians working those locations, 43% of PAs and 52% of NPs were practicing in primary care.

Based on the data in the NPI, “we are finding that the trends towards subspecialization we see among physicians are also occurring in the nurse practitioner and physician assistant communities,” Andrew Bazemore, MD, MPH, director of the Robert Graham Center, said in a statement.

"Some factors that influence physicians to choose subspecialty careers may have similar effects on NPs and PAs, including student debt and income gap disparities," the researchers wrote.

In 2008 the average student debt for PAs was $100,000, while a four-year nursing degree can range between $25,000 and at least $100,000. These debt loads could make specialty practice more attractive than primary care.

"The future of primary care will depend on teams of providers from various disciplines and educational policies that foster those teams," Bazemore said. "Given what we know of primary care impact on costs, patient health and population health, we risk falling well short of our nation’s health care workforce goals if efforts to increase the production of physicians, nurse practitioners and physician assistants aren’t paired with efforts to further encourage trainees in each discipline toward careers in primary care."