The Shortage of Primary Care Physicians and Impact on the Nurse Practitioner Shortage

Nurse practitioners will be in high demand, according to healthcare industry experts. Due to a shortage in the number of primary care physicians available to treat patients, a growing and aging population combined with the need for healthcare services in many underserved communities, the demand for nurse practitioners will only continue to increase in the coming years.

A shortage of physicians and nurses will continue to provide many opportunities for RNs looking to expand their careers into the advanced practice nursing field. The nurse practitioner profession also provides a degree of autonomy since nurse practitioners work both independently and in collaboration with health care providers, especially in rural areas where there is often no other healthcare provider available to treat patients.

In response this shortage of healthcare professionals, many different programs have been created to recruit more people into the nurse practitioner and registered nursing professions. This includes expanded nursing education programs, grants and scholarships. Based on the data and current market, now is an excellent time to enter the field of nursing or make a career change.

Nurse Practitioners Play a Very Important Role in Health Care Delivery System

With so many people in the U.S. uninsured and as the nation continues its debate over affordable health coverage, more people will be demanding primary care services. Due to the shortage of physicians, the availability of health care services is at risk of becoming extremely scarce unless more physicians are able to serve patients. Nurse practitioners are advanced practice nurses uniquely qualified to meet this demand.

Nurse practitioners are able to provide primary care services to many underserved groups and populations such as the elderly, women, children and the homeless in many nontraditional environments like health departments and schools at a much smaller cost than that of a physician.

According to Kathryn Donahue, a spokesperson for the California Nurses Association, nurse practitioners help to fill a void. “Nurse Practitioners fill a vital role in health care access, in both primary and preventative health care. They maintain a case load of patients. This patient population once routinely saw their personal MD -- the Family Practice MD. With the multiple changes in how health care is managed in a for profit system, and while the monetary reimbursement of physician services is dictated by a profit driven industry, the great majority of medical students choose to study and then practice in medical specialty areas."

The general practitioner (GP) numbers are dwindling. Advanced practice nurses fill this void. They provide basically the same services the GP provided, at a much lower cost. They provide patient education, promote healthy life style choices, spend time and energy to assist their patients in becoming (healthier) and maintaining optimum health. As in the nursing practice model, NPs provide individualized, safe, competent, therapeutic patient care”, explains Kathryn.

The History of Nurse Practitioners

Nurse practitioners began as a strategy to increase patient access to primary health care services. The University of Colorado in 1965 developed the first program to prepare nurse practitioners. They worked with physicians and were able to assess and diagnose health problems for children. In the mid 1970s there were mostly certificate programs available throughout the country preparing nurses to deliver primary care to patients. Master's degree nursing programs began to surpass the number of certificate programs by the 1980s. As a result of many healthcare reforms during the 1990's, nurse practitioner programs grew.

Nurse practitioners continued growing in their autonomy as well as in numbers which was in response to the need for cost-effective and more accessible health care services. As their influence and presence increased, nurse practitioners pursued more economic and professional recognition within the healthcare industry. In an effort to define and clarify the focus of their practice and to meet government regulation requirements for reimbursement, certification and titles became available through advance practice nursing organizations. The National Council of State Boards of Nursing helped establish education and training standards such as the master’s of science in nursing (MSN) degree and licensing as an RN which became the minimum requirements needed to become a nurse practitioner.

The American Academy of Nurse Practitioners also worked to develop standards of nursing practice that specified the duties of the nurse practitioner and governed the services that were provided. These standards involved qualifications needed to become a nurse practitioner, care delivered, work environment, documentation, collaborative responsibilities, quality assurance, patient advocacy, research and supporting roles.

The work of a nurse practitioner is characterized by a focus on disease prevention, health promotion, diagnosis and management of common acute injuries and illnesses as well as stable chronic diseases. Counseling and educating patients and their families on healthy lifestyle habits are also characteristics of nurse practitioner care.

What is a Nurse Practitioner?

A nurse practitioner is a registered nurse with advanced nursing education and training at the graduate level within a special healthcare practice area. Nurse Practitioners often serve as the primary health care provider for patients especially in rural areas and underserved communities. They gather patient medical histories, give physical exams, monitor patient diseases, provide preventative health care, order lab tests and x-rays and educate patients and their families. In some states they are also allowed to prescribe medications.

Nurse practitioners often work autonomously as well as collaborate with different healthcare professionals to diagnose and manage patient health especially in areas with little access to health care services. In certain settings, a nurse practitioner may be the only healthcare provider in an underserved area such as rural communities. In this type of environment, the nurse practitioner works more independently consulting with physicians when necessary. The nurse practitioner usually provides initial care and manages care for patients who have minor acute and chronic conditions that are stable. The nurse practitioner and physician work closely together and the nurse practitioner may consult with the physician when needed for more a complex diagnosis or treatment plan.

For registered nurses (RNs) looking to make a career change that offers autonomy, challenge and higher pay, a nurse practitioner position is a great option to explore. Their responsibilities include tasks that were once primarily done by physicians. Nurse practitioners provide very similar services such as physical exams, writing prescriptions and reviewing diagnostic tests. Since nurse practitioners are involved in educating patients and the community on healthy lifestyle habits and practices, the ability to communicate, be sensitive and understand the needs of patients are important to this line of work.

In summary, nurse practitioners are involved in the management of patient care which may include:

  • Determining the needs of patients and their families based on information that is collected from them
  • Implementing treatment plans
  • Educating patients on preventative and follow up care
  • When needed, provide referrals to health care specialists or agencies
  • Monitor patient progress, reassess or adjust care plans to achieve optimum health

Nurse practitioners work with physicians and other medical professionals to provide comprehensive healthcare for their patients. They refer patients to physicians when needed and may work independently. They might specialize in certain health areas such as pediatrics, geriatrics, mental health, family practice, neonatology or acute care.

Nurse practitioners are becoming more common in physician’s offices because of their wide range of skills. They provide physician offices with another highly trained health professional able to work independently which can take the load off of many busy, overworked physicians.

They also are better educated now and perform many more procedures compared to 40 years ago. They also increasingly work more independently in various specialties and healthcare environments. Nurse practitioners earn between $69,885 and $90,618 per year according to Payscale.com.

Nurse Practitioners Are In High Demand in Many Areas

Job opportunities for RNs (which includes nurse practitioners) are projected to be excellent and grow much faster than the national average relative to other occupations according to the U.S. Bureau of Labor Statistics (BLS). Employment of RNs is expected to grow by 22% until 2018. A lot of this will be due to the many technological advances in healthcare which allow for a wide variety of illnesses and injuries to be treated.

Advanced practice nursing which includes NPs will continue to be high in demand in many underserved communities including rural and urban areas. In addition to serving as a lower cost alternative, the demand for NPs will also come from the shortage of available primary care physicians to treat patients.

In an effort to recruit and retain nursing staff, hospitals may offer more sign on bonuses, flexible work schedules and tuition reimbursement for training. Physician offices will see the most employment growth at 48%. As more procedures once only available through hospitals are able to be carried out in outpatient centers, physician offices and ambulatory care centers. This will provide more job opportunities for NPs and RNs in general.

The Physician Shortage

A 2008 report released by the Association of American Medical Colleges (AAMC) shows that the U.S. is facing a shortage of physicians that will last until at least 2025. Since a shortage of primary care physicians can result in patients having limited access to healthcare services and longer wait times, this is causing a big concern amongst healthcare experts.

This physician shortage is being attributed to growth in an aging population that will drive the demand for healthcare specialties focusing on elderly care. In addition, growth in the overall U.S. population by more than 50 million through 2025 is projected by the US Census Bureau, which means that the nation will need to provide healthcare to a growing population using new tactics. Experts are also warning that there may not be enough physicians to treat people who will be eligible for coverage under the new healthcare law. The AAMC also projects that there will be a shortage of 150,000 doctors in the next 15 years.

Primary care physicians will be the most in demand. Although the U.S. has about 352,908 primary care doctors currently, the AAMC is estimating that at least 45,000 will be needed by the year 2020. The number of medical students entering the field of primary care has fallen more than a quarter within the last few years. Which is adding to the demand for nurse practitioners with family nurse practitioner training.

Another cause in the doctor shortage is due to the lack of medical resident positions available. Medical students are required to do a three year medical residency where they are trained at hospitals and medical centers. Fewer residencies means less medical students are graduating to fill the shortage.

In many rural areas, it is very hard to find a doctor. According to the Council on State Governments, sixty million people live in over 3,000 shortage areas as designated by the Health Resources and Services Administration. Not having enough doctors in those areas means that patients have to wait longer in doctor's offices, travel longer distances to see a physician, receive less preventative treatment and experience poorer outcomes after serious illnesses and traumatic injuries. In addition, many hospitals in rural areas have had to close due to financial difficulties and many others are at risk of closing which is further exacerbating the problem of access to medical care in those communities.

In an effort to provide a solution to the shortage, the AAMC has proposed increasing enrollments in medical schools by expanding educational programs and creating new ones. This would create 5,000 additional physicians annually. Some states are offering incentive packages to get physicians to provide healthcare services in underserved locations. Given the fact that many medical students take out loans to fund their education and often graduate with a large amount of debt, some states have implemented loan repayment or forgiveness programs and scholarships. The federal government provides educational assistance through the National Health Service Corps to healthcare professional who agree to work in a shortage area for two years. Several states also provide tax incentives and grants to physicians working in underserved areas.

Many health care groups and experts have proposed solutions to the physician shortage that include increasing medical school enrollments and the number of schools that are available. The AAMC has also suggested increasing medical school graduates by 30%. Alternative solutions to the problem include also changing the way health care is delivered by utilizing other health care professionals like nurse practitioners and physician assistants. This will entail allowing them to play a more significant role in the providing of health care services. Traditional beliefs have long held that only physicians are able and qualified enough to treat people. This has proven to not be the case as many nurse practitioners and physicians assistants are working side by side with physicians to treat patients. In many cases, they are even working independently.

The Nursing Shortage

In addition to the physician shortage, hospitals need roughly 116,000 Registered Nurses to fill vacancies throughout the United States, according to a 2007 report released by the American Hospital Association. This data equates to an 8.1% vacancy rate in the U.S. Health care professionals and policymakers are on the hot seat and working diligently to find solutions.

Not having enough nursing faculty available to teach at nursing schools also makes the situation complicated. Every year, nursing schools have to turn qualified applicants away because they don’t have adequate faculty to teach students. To address this issue, federal and state funding has been provided in the form of educational scholarships, recruitment and retention programs. The 2009 American Recovery and Reinvestment Act has allocated funding directed to nursing training and education.

A study conducted by the Southern Regional Board of Education found that the cause of the nursing shortage in 16 states was linked to a shortage of faculty due to vacant teaching positions, resignations, retirements and not enough applicants to fill these positions at colleges and universities. This has obviously had a very negative effect on the current nursing shortage.

What is Causing This Nursing Shortage?

The nation has experienced staffing shortages within its healthcare system at different times in history. According to Mark Genovese, a spokesperson for the New York State Nurses Association, in the past, hospitals had many financial constraints, “For many decades the shortage was cyclical but as the economy tightened and as the insurance industry moved to a managed care model, there was less money in the system and hospitals had less money to work with and tighter budgets.”

The current nursing shortage is unique in that the catalysts are linked to a wide range of factors. The nursing shortage is associated with factors influencing supply and demand, population growth, demographic changes, less students in nursing programs, retirement or leaving the workforce for other careers and a rise in the aging population who are predicted to create greater demand for healthcare services over the next several years. These things are happening in tandem with nurses who are retiring and while more nursing positions are being created. The shortage of nurses is a worldwide issue that is affecting Western Europe, the Philippines, Canada and Australia.

The shortage of nurse educators who are needed to train the next generation of nurses at colleges and universities around the U.S. has also contributed to the shortage as many students are denied entrance into nursing school due to limited resources. A report released by the AACN found that nursing education programs in the United States were not able to accept 49,948 qualified applicants into bachelor’s and master’s degree programs because there were not enough faculty or means available to teach students. The Southern Regional Board of Education completed a study finding that the nursing faculty shortage was caused by retirement, vacant faculty positions, a shortage of new faculty candidates applying for positions at colleges and universities and resignations.

Current Actions Being Taken to Resolve The Problem

Legislation has been created to assist in providing funding for the education of nurses, At the state and federal levels, recruitment and retention programs have been developed or are currently in development designed to address the current nursing shortage and what the future might hold. The 2009 American Recovery and Reinvestment act, a federal program, has allocated funds to professional training and education in the fields of health care and nursing which is predicted to have a positive growth impact on the Nation’s health care work force. The majority of states are also developing programs that offer nursing scholarships and loan forgiveness options to nurses that meet specific requirements. The goal here is to promote specific fields of nursing that will ultimately help alleviate nursing shortage concerns.

Efforts to Expand the Role of Nurse Practitioners

An April 2010 Associated Press article reported that 28 states are looking into expanding the authority that nurse practitioners have. Nurse educators are looking into having nurse practitioners obtain doctorates or a DNP as the standard in education and training by 2015.

New laws are also compensating nurse practitioners, increasing their availability. Medicare pays nurse practitioners 85% of what is paid to doctors. The new healthcare overhaul gave advanced practices nurses like nurse midwives a Medicare raise to 100% of what obstetrician and gynecologists earn.

In Massachusetts, a law was passed in 2006 that expanded health insurance to most residents. In 2008, another law was passed that required health plans to reimburse nurse practitioners like primary care providers. These changes are providing more opportunities for nurse practitioners to meet the demand for more healthcare services as well as increase the attractiveness of becoming a nurse practitioner

How Can You Become a Nurse Practitioner?

To become a nurse practitioner, you will need to first become a registered nurse. Becoming a registered nurse can be accomplished in different ways. One is through obtaining an associate’s degree, usually through a community college. Other paths include attending a diploma program which takes three years to complete or obtaining a bachelor's degree through a nursing program at a college or university. Most nurses obtain an associate’s degree through community colleges and private schools. The next most commonly held nursing degrees are a bachelor’s of science in nursing (BSN) degree and a nursing diploma.

Since nurse practitioners must have a master’s of science in nursing (MSN) degree to practice, obtaining a BSN degree is a prerequisite. Typical courses included in a BSN program include anatomy, physiology, nutrition, mathematics, chemistry, nursing theory, humanities, social sciences and English. In addition, clinical training is also required. Online RN to BSN programs have become the main route to earning a BSN degree for associate and diploma educated registered nurses, who choose to continue working while pursuing a baccalaureate degree in nursing. After completing a BSN, students must complete an MSN degree program with a nurse practitioner focus or specialization, which prepares them to practice in that nurse practitioner specialization. There are a variety of nurse practitioner programs offered through out the United States with a wide selection of specializations to choose from. In an MSN nurse practitioner program, generally students learn about acute care, health sciences, public health, administration and nursing specialties.

Experience will also help an RN gain employment as a nurse practitioner. According to Magdy Mahmoud, manager at Everest Medical Services, a medical staffing company in New Jersey, education plus past work experience greatly helps RNs looking for jobs. “…it does really matter about the quality of education that a nurse has prior to employment. In addition past experience is really important, if the nurse has been working for quite some time, multiple jobs adds value along with good references. We always contact between 3 and 6 past employers and ask for past employment references, and that has a big weight”, explains Magdy.

Besides education and experience, having the right skill sets to work in the nurse practitioner profession are also essential. To be a nurse practitioner, one must be genuinely interested in helping and caring for others. In addition, nurse practitioners also need to be responsible, sympathetic, detail orientated, have analytical and good problem solving skills needed to accurately identify and diagnose a wide range of medical problems. Strong interpersonal skills, emotional stability and the ability to listen to patients helps nurse practitioners work with patients suffering from pain and illness. The ability to handle stress, emergencies and collaborate with other medical professionals allows nurse practitioners to deliver quality care.

Why Nursing Higher Education is Important

Higher education in nursing provides nurses with in depth training in the area of physical science, nursing research and management, social sciences, humanities and public health. This allows nursing students to grow professionally and truly understand the many factors that impact the health of a patient which are often related to social, economic and cultural influences.

The relationship between nurse education and patient care has been documented in a 2003 study published by the Journal of the American Medical Association. The study found that hospitals that employed a higher numbers of RNs with a bachelor's or graduate degree had surgical patients who experienced lower mortality rates concluding that education levels often result lower patient mortality.

Proper training and education are becoming even more important as nurses will be required to handle more complex tasks. Advances in medicine and patients being discharged more rapidly has resulted in a higher demand for acute healthcare services. Many healthcare organizations are also expanding their intensive care units and including services that treat many different types of illnesses and injuries which is creating a demand for highly trained and educated, skilled RNs to work in these facilities.

Now Is a Great Time to Become a Nurse Practitioner

With the growing physician and RN shortage, advance practice nursing is a high demand field. Healthcare industry experts and policymakers have realized this and many programs are available to help fund nursing education. If you are looking to explore a rewarding career and improve the lives of other people, nursing might very well be an excellent choice. Nurses often enjoy flexible hours and competitive pay rates. The nursing profession also provides the opportunity to work in diverse environments. Advanced practice nurses such as nurse practitioners can even specialize in pediatrics, neonatal, geriatrics, mental health and primary care for instance.

Working as a nurse practitioner can be a rewarding experience. Becoming a nurse practitioner has also become easier than in the past. There are many nursing degree programs available which include both online and on campus programs. RNs looking to advance in their profession can take classes part-time. Those interested in becoming a nurse for the first time will be happy to learn that there are many scholarships and grants available to go back to school as well. Now is a great time to become a registered nurse and enter the medical profession in general. Learn about the many options available!

Sources: BLS, "Facing doctor shortage, 28 states may expand nurses' role" Carla K . Johnson, Associated Press, April 16, 2010, Medscape, American Association of Colleges of Nursing)

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