Every year, the American population grows a little older. Some 10,000 people turn 65 each day in the United States, and by 2030, every Baby Boomer will be of retirement age. By 2050, more than 20% of the American population will be 65 or older. As these people age, their healthcare needs will increase dramatically, and experts predict there won’t be enough trained physicians to care for them all. In fact, the Association of American Medical Colleges (AAMC) projects a shortfall of up to 139,000 physicians by 2033. This deficit could diminish the quality of care and decrease access for vulnerable populations regardless of their age.
To overcome this anticipated shortfall, many government agencies and healthcare systems are encouraging the use of advanced practice providers (APP) like physician assistants (PA) and nurse practitioners (NPs). While these providers require less education than doctors and can provide their services at a lower cost, their training makes them highly suitable in primary care scenarios. Deploying these workers in tandem with physicians allows doctors to magnify their efforts by working more efficiently.
Advanced Practice Provider Use is Growing
APP healthcare positions have proliferated over the last two decades. Between 2007 and 2008, about 29% of hospitals utilized NPs, and 21% utilized PAs. By contrast, the most recent data from the Society of Hospital Medicine shows that 63% of practices now use APPs. That growth has impacted patient visit data. Between 2012 and 2016, visits with NPs and PAs increased by 129%, while office visits with primary care physicians dropped 18%.
It’s evident that APPs are here to stay. So, physician and clinic groups that want to take advantage of everything these healthcare workers have to offer must find effective ways of utilizing them.
Typical PA and NP Utilization Models
Deploying healthcare resources is always a challenge. However, when it comes to utilizing NPs and PAs, four potential models rise to the surface.
The Dyad Model
In this scenario, a physician and APP split a panel of patients. The APP handles all aspects of their patient’s care and then compares notes with the physician. This model allows practices to see more patients at a lower price while also creating back-up and redundancy support for both the physician and APP.
The Observation Model
Under this model, the PA or NP handles most patient management and billing duties, with a physician available for consultation and back-up. The observation scenario is an extremely efficient way to utilize APPs and allows them to work at their highest level.
The Admissions Model
Here, a PA or NP handles late afternoon and evening hospital admissions while also starting diagnostic work-ups and treatment plans. The physician then takes over patient care the next day and often bills for admission.
NPs and PAs often work in long-term partnerships with surgical teams. In these relationships, APPs handle chronic conditions, allowing surgeons to work at the top of their license. In a co-management services arrangement, APPs often bill for their services separately.
In some utilization scenarios, APPs work very independently. These could include critical access hospitals with APPs working at night or in rural clinics with provider shortages. Fortunately, advances in telemedicine technology allow for more immediate physician support if necessary.
Regardless of the utilization model, it’s critical to ensure that the APP has the skills, experience, training, and confidence necessary for their role. It’s also crucial that the APP feels satisfied with their function; otherwise, the relationship may not be long lasting.
More Independent Roles on the Horizon?
Some government agencies are pushing to allow APPs to work outside the most common utilization models. In September, Governor Gavin Newsom signed a new law allowing California NPs to practice medicine independently after working under a doctor’s supervision for at least three years. Previous California law required NPs with a master’s or doctorate degree to always operate under a doctor’s supervision. Lawmakers designed this new provision to increase the number of primary care physicians in the state, especially in rural and low-income communities.
While this new law is beneficial for NPs, many physician groups, including the AMA, oppose such laws because they believe APPs need to continue working under a doctors’ supervision. The groups argue that team-based care is very different from private practice models, and NP and PA training just doesn’t match the rigorous training physicians receive.
The Future is Here
Whatever role NPs and PAs end up taking, it’s clear they’ll play a critical role in American healthcare delivery. That’s why forward-thinking providers and hospital systems would be well-served to begin utilizing these professionals today. That way, they can find the most efficient methods for APPs to support physicians, practice revenue, and patient care now and into the future.