The pending primary care shortage may be more about the type and scope of practice of providers than the number of primary care physicians, and can be best addressed by implementing promising strategies that fully utilize non-physician health care professionals in new systems of care.
This is the conclusion of a new research brief, co-authored by Interdisciplinary Nursing Quality Research Initiative (INQRI) Co-Directors Mary Naylor, PhD, RN, FAAN, and Mark Pauly, PhD, with Janet Weiner, MPH, associate director for health policy at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. INQRI is funded by the Robert Wood Johnson Foundation (RWJF).
The brief, Primary Care Shortages: It’s More Than Just a Head Count, examines how the Affordable Care Act (ACA) will affect the delivery of primary care, and reviews recent research on the primary care shortage and possible strategies to address it.
The brief notes that, with the ACA feeding demand for primary care services, some people may face increased wait times for appointments and Medicaid recipients may have difficulty finding services if they look only for primary care physicians to see them.
Several strategies show promise for addressing these problems. Among them is the ACA’s investments in health professional education and training to increase the number of primary care providers, including nurse practitioners (NPs) and physician assistants. There are also incentives to increase the effectiveness of the primary care workforce through models like medical homes and Accountable Care Organizations. Other models, like retail clinics, hold promise for ensuring that more people can access primary care services, particularly in rural areas, the brief says.
Allowing health care providers to practice to the full extent of their education and training is an important strategy that can help improve the availability of primary care.
“A wealth of studies comparing the quality of care provided by physicians and NPs have found no difference in clinical outcomes or patient satisfaction,” the brief says. Ensuring that providers can practice to the full extent of their knowledge and training requires changing state regulations, since fewer than half the states permit advanced practice registered nurses (APRNs) to diagnose, treat, and refer patients and to prescribe medication without physician supervision. The National Governors Association has endorsed broadening the scope of practice for APRNs.