Narrowing the Primary Care Gap

The primary care shortage in the US is destined to grow even more dire as indicated in an article featured in February 12th issue of the Washington Post.  In light of the Healthcare Affordability Act there will be a need for at least 30,000 more primary care providers given the fact that tens of millions more individuals will likely enter the healthcare system.  Many of whom have not had adequate care for many years, if ever.

The deficiency of primary care physicians is not a new phenomenon.  For the last few decades a variety of factors ranging from the economic to ego tend to steer graduating physicians away from primary care toward the lucrative and esteemed medical specialties.  The article highlighted the significant debt carried by many graduating physicians noting that one-third of the class of primary care residents at Children’s National Medical Center in Washington DC carry more than $200,000 in student loan debt.  Couple that with the significant salary disparity between primary care and specialists, it is easy to rationalize the decision to pursue a specialty over primary care.

Among the solutions examined in this article including federal initiatives to close the primary care gap, a discernible exclusion is the role of mid-level practitioners (nurse practitioners [NPs]/physician assistants [PAs].  In the U.S., NPs and PAs have been practicing as far back as the 1960’s and 70’s when the professions were created in response to a shortage of healthcare providers.  This has since evolved into more than 150,000 NPs and 74,000 PAs in the U.S. according to the ACNP and AAPA respectively.  While the role has branched out to multiple specialties, the mainstay remains primary care. 

Thus, a large proportion of the mid-level practitioner population is ready and willing to take on primary care roles.  A recent white paper published by Snowfish featured results of an analysis including 500+ NPs and PAs. It noted that in general mid-level practitioners are very suitable to manage non-urgent issues and management of chronic conditions such as diabetes, hypertension, and dyslipidemia.  A sizeable number of mid-level practitioners function autonomously. Though their specific responsibilities vary depending upon the specialty and clinical setting, it is clear from the survey that NPs and PAs are involved in all aspects of disease state management.  In many of the responsibilities described, there is little distinction between these clinicians and physicians.  Furthermore, by 2015, all newly graduated NPs will require a doctorate degree (DNP). 

In any case, the future of primary care may essentially be the shift away from the individual provider model toward the patient-centered “medical  home”, in which a team approach is used to optimize patient outcomes.  The obvious leader of this team would be the primary care physician who will use their years of education and rich understanding of physiology and disease management to guide the delivery of high quality care.  Those ideal to deliver these services under such leadership are the mid-level practitioners.

As it takes much less time to graduate quality mid-level practitioners than it does for physicians, this is an excellent solution to filling the primary care gap while ensuring that delivery of primary care to the management of the millions of newly insured patients remains the best it can be.  

Snowfish is uniquely positioned to provide executive decision makers with critical investment insights. We integrate clinical, business, and analytics to meet a client's specific and specialized objectives. We are happy to provide the mid-level practitioner survey results discussed in this blog entry.  More information on the survey and Snowfish is available at www.snowfish.net and by calling Snowfish at +1-703-759-4547.