Contributor: Hailey Merk - Client Services Intern, Emmi Solutions
I hear my name called by what appears to be a nurse at my last routine doctor’s appointment. She records my height, weight and blood pressure but, to my surprise, doesn’t leave to call in the physician after she’s finished. She explains that she is also a primary care provider and will be assisting me with my healthcare needs. I am surprised, but the entire visit goes smoothly and I leave a happily satisfied patient.
You may have experienced a similar doctor’s appointment since the implementation of the Affordable Care Act because physician assistants and nurse practitioners have been freshly integrated into the healthcare system as primary care providers. The ACA defines a primary care provider as “a clinician who provides integrated, accessible health care services and who is accountable for addressing a large majority of personal health care needs, including providing preventive and health promotion services for men, women and children of all ages, developing a sustained partnership with patients and practicing in the context of family and community.” These “new docs on the block” have the ability to help alleviate the shortage of primary care physicians being harshly felt throughout the healthcare system. They are working together with physicians to create patient-centered medical homes, to emphasize team-based care and to provide higher quality care to an amplified population of patients.
According to the National Conference of State Legislators, the Affordable Care Act will expanded insurance coverage and access to healthcare to about 32 million new patients by 2019. The Health Resources and Services Administration (HRSA) projects a shortage of 20,400 primary care physicians by 2020. In addition, aging and population growth are projected to account for 81 percent of the change in demand between 2010 and 2020.
HRSA currently designates over 6,200 Health Professional Shortage Areas (HPSAs) for primary care nationwide, in which over 65 million people live. Sixty-seven percent of HPSAs are in rural areas. The ratio of primary care providers to patients in these areas is less than one per 2,000. Physicians alone will not be able to care for this growing population of patients.
The major barrier arises from the residencies that medical students are required to complete before they can become a practicing physician in their field. There remains to be an insufficient amount of Medicare funds to put enough physicians through residency to care for the outstanding number of new patients.
Physician assistants, on the other hand, do not require a residency. Their graduate education is drastically less expensive, lasts only about two years, and many schools model their physician assistant programs alongside their sophomore year medical programs. The Affordable Care Act has allocated funds for new physician assistant training programs around the country, especially in rural and under-served communities where the health professional shortage areas are quickly expanding. It acknowledges the critical role of physician assistants in the healthcare workforce and has reduced barriers to practice in state laws and other limiting regulations. This will change the medical care landscape for access to care by allowing physician assistants to practice in traditional settings like hospitals and nursing homes as well as in modern clinics at retail centers like Walgreen's, businesses and urgent care centers. The Kaiser Permanente Center for Health Research found that patient satisfaction levels based upon interpersonal care, confidence in the provider and understanding of patient problems ranged between 89 and 96 percent for physician assistants.
A nurse practitioner is an advanced practice registered nurse with a master’s or doctoral degree and they are licensed through the state nursing board instead of the medical board. Authority varies but most nurse practitioners are able to practice independently of physicians. The emerging strategy to practice together is an interdisciplinary model where both providers collaborate to provide patient-centered care. The patient-centered nature of nurse practitioner training, which often includes care coordination, population health management and sensitivity training for family situations, mental health, and social-cultural factors, provides primary care services with a new scope and perception for practice. The Affordable Care Act has allocated millions of dollars for the education and clinical training of nurse practitioners for development of nurse-led clinics that provide care in underserved areas. According to the 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, there is a “proven track record” of nurse practitioners providing care across populations and settings.
Healthcare technology is also making it possible for physicians to supervise and to sign off on their physician assistants from virtually anywhere. This remote supervision is making the physician assistant model of healthcare even more feasible. This approach promotes the physician communication channel with multiple physician assistants and allows for more patients to be cared for. Patient engagement technology also facilitates delivery of care by physician assistants and nurse practitioners by providing patients with expert consultative, preventative and safety information signed off by a physician. Patient engagement technology also enables the patient to participate more effectively in shared decision making conversations because they have been presented with the options beforehand and understand what treatment plan is right for them.
As the healthcare system evolves, technological innovations and new training models are helping “the new docs on the block” to fill the gaps in primary care so that each patient can receive holistic care across the entire continuum of their healthcare experience.
Hailey is a Client Services Intern at Emmi Solutions. She is a student at the University of Illinois majoring in Interdisciplinary Health and hopes to continue her passion for medicine as a Physician Assistant in the future.