Characteristics of nurse practitioners and physician assistants in the United States (original) (raw)

Gaps in the Supply of Physicians, Advance Practice Nurses, and Physician Assistants

Journal of the American College of Surgeons, 2011

BACKGROUND: Based on the goals of health care reform, growth in the demand for health care will continue to increase the demand for physicians and, as physician shortages widen, advanced practice nurses (APNs) and physician assistants (PAs) will play larger roles. Together with physicians they constitute a workforce of "advanced clinicians." The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services. STUDY DESIGN: Projections were constructed to the year 2025 for the supply of physicians, APNs, and PAs, and these were compared with projections of the demand for advanced clinical services, based on federal estimates of future spending and historic relationships between spending and the health care labor force.

Physician assistants and nurse practitioners: a missing component in state workforce assessments

Journal of Interprofessional Care, 2011

Due to current or predicted health workforce shortages, policy makers worldwide are addressing issues of task allocation, skill mix, and role substitution. This article presents an example of this process in the United States (US). Health workforce analysts recommend that US physician workforce planning account for the impact of physician assistants (PAs) and nurse practitioners (NPs). We examined 40 state workforce assessments in order to identify best practices for including PAs/NPs. Most assessments (about 60%) did not include PAs/NPs in provider counts, workforce projections or recommendations. Only 35% enumerated PAs/NPs. Best practices included use of an accurate data source, such as state licensing data, and combined workforce planning for PAs, NPs, and physicians. Our findings suggest that interprofessional medical workforce planning is not the norm among the states in the US. The best practices that we identify may be instructive to states as they develop methods for assessing workforce adequacy. Our discussion of potential barriers to interprofessional workforce planning may be useful to policy makers worldwide as they confront issues related to professional boundaries and interprofessional workforce planning.

Physician Assistants and Nurse Practitioners

Annals of Internal Medicine, 1994

examines expanded roles for physician assistants and nurse practitioners in light of projected shortages of primary health care providers. Meta-analyses and other literature reviews comparing the care provided by nurse practitioners and physician assistants with that by primary care physicians had methodologic shortcomings that made the data difficult to interpret. There were no studies comparing nurse practitioners in independent practice with physicians. Seven policy positions are articulated.

The 2013 census of licensed physician assistants

JAAPA : official journal of the American Academy of Physician Assistants, 2014

A census of physician assistants in the United States is necessary to help legislators make policy decisions about the profession. In 2013, a PA status analysis was undertaken using a novel data source derived from state licensure. The Provider 360 Database was probed for all licensed PAs, and 84,064 were identified. Duplicates, sanctioned, deceased, and dual-licensed were reconciled. In the aggregate, the mean age was 42 years (median 45; mode 32; range 22-74) and 75% of US licensed PAs were women. Statewide distribution per capita ranged from 60 per 100,000 in Alaska to 3.9 per 100,000 in Mississippi; the US mean was 26.8. The robustness of this database draws on active licensure data to identify clinically active PAs. Such refinements and details contribute to health workforce research such as census, modeling, retirement trends, and labor participation rates.

The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

The Gerontologist, 2005

Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher Medicaid rates, and those in more competitive markets and markets with higher managed care penetration, are more likely to employ NPs or PAs. The Online Survey Certification and Reporting System (OSCAR) database, Area Resource File, and information from surveys of state policies from 1993 to 2002 are used to study the employment of NPs or PAs, using a cross-sectional time-series generalized estimating equation model with surveys nested within facilities, testing several market and state-policy effects while controlling for facility and market characteristics. Throughout the 1990s the proportion of nursing facilities with NPs or PAs doubled, from less than 10% to over 20%. Facilities in states in the upper quartile of Medicaid reimbursement rates were 10% more likely to employ NPs or PAs. Facilities in more competitive markets, and in markets with higher managed care penetration, were more likely to employ NPs or PAs (adjusted odds ratio = 1.27, 1.20 respectively). More generous state Medicaid nursing home reimbursement and higher competition may advance the investment in medical infrastructure, which in turn may positively affect the quality of care provided to nursing home residents.

Supply of physician assistants: 2013-2026

JAAPA : official journal of the American Academy of Physician Assistants, 2014

As part of healthcare reform, physician assistants (PAs) are needed to help mitigate the physician shortage in the United States. This requires understanding the population of clinically active PAs for accurate prediction purposes. An inventory projection model of PAs drew on historical trends, the PA stock, graduation estimates, retirement trends, and PA intent to retire data. A new source of licensed health professionals, Provider 360 Database, was obtained to augment association information. Program growth and graduate projections indicated an annual 4.7% trend in new entrants to the workforce, offset by annual attrition estimates of 2.9%. As of 2013, there were 84,064 licensed PAs in the United States. The stock and flow equation conservatively predicts the supply of PAs to be 125,847 by 2026. Although the number of clinically active PAs is projected to increase at least by half by 2026, substantial gaps remain in understanding career trends and early attrition influences. Furth...

Career Flexibility Of Physician Assistants And The Potential For More Primary Care

Health Affairs, 2010

In part because of their core generalist education, physician assistants can change clinical specialties over the course of their work life. This is known as career flexibility. Using medical care providers who can adapt quickly to new opportunities could help alleviate medical workforce shortages in primary care. We studied annual surveys undertaken by the American Academy of Physician Assistants to determine how many physician assistants changed specialties and how frequently. Over four decades, 49 percent of all clinically active physician assistants changed specialties sometime in their careers. This suggests that incentives, such as educational grants, could draw more physician assistants to work in primary care. These findings suggest that an array of new incentives under health reform could draw and retain more physician assistants into primary care medicine.