The Shortage of Primary Care Services: Utilizing Nurse Practitioners and Physician Assistants to Relieve the Crisis

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It is evident that the American system of health care is in need of an overhaul. Current figures indicate that there are over 46 million people who are uninsured. This equates to 15% of our nation's citizens who may not be able to access health care. The American College of Clinicians submits that Physician Assistants (PAs) and Nurse Practitioners (NPs) already significantly improve access to primary care services, but are underutilized in our current health care delivery system.

It is evident that the American system of health care is in need of an overhaul. Current figures indicate that there are over 46 million people who are uninsured. This equates to 15% of our nation's citizens who may not be able to access health care. The American College of Clinicians submits that Physician Assistants (PAs) and Nurse Practitioners (NPs) already significantly improve access to primary care services, but are underutilized in our current health care delivery system.

While fewer physicians are choosing primary care, a new paradigm exists. But there has been a systemic failure to recognize that the skills and knowledge of PAs and NPs makes them well qualified to fill the role of primary care provider. Even though these individuals demonstrate excellence in the provision of primary care, barriers and territorial arguments rule. This is a perpetuation of the belief that only physicians should or can provide primary care. While no longer true, this belief creates barriers for other clinicians. Restrictions need to be removed to allow all professionals to be utilized to their fullest potential. PAs and NPs have been providing professional, high level, primary care services for over forty years. There are over 200,000 of these advanced practice clinicians (APCs) across the USA. Many have the experience and are looking for the opportunity to provide health care in a way that helps to heal the system.

Often decisions about patient care are driven by insurers based on profit margins, not medical need. This has led to the dissatisfaction of many providers, especially physicians, creating an exodus from the primary care setting. This shortage is also complicated by the failure of policy makers to recognize that APCs are already meeting primary care needs across the country, and doing it well. Numerous studies which compare physician and APC health care outcomes have shown either equivalent or superior outcomes for NPs and PAs. Nurse Practitioners and Physician Assistants can and do staff primary care clinics across the country.

There are multiple models which could be used to expand NP and PA services, including the expansion of the retail clinic model to offer chronic illness care as well as health care for acute illnesses, with a focus on prevention. Clinicians would provide early screening and treatment for illnesses, which when left untreated; have a significant financial impact on both the patient and the system. Several channels may provide funding for these clinics. The first would allow them to be outgrowths of current private sector practices. The clinics could also be funded through government-sponsored grants, similar to current programs such as the Public Health Service. Agreements with consultants, specialists, hospitalists and local hospitals would provide seamless coordination of care. The system would begin to provide essential and critically needed services promptly, while policy makers continue to evaluate and fine-tune the details. NP's and PA's are also perfectly poised to play key roles in the emerging Medical Home model where they can provide astute patient-centered care.

As we look to the future, the ACC encourages those involved in medical education to consider the benefits of the team approach to clinical teaching. One strategy might be to allow NPs and PAs into primary care residency programs that have been traditionally restricted to physicians and use Medicare funding for part of that funding. Another would be to develop similar programs for NPs and PAs. For the APC who is new to the field or who desires to move into primary health care, this would be a wonderful opportunity to boost the number of providers in the primary care arena. Another strategy might be to recruit and support returning war veterans who wish to pursue careers in primary health care.

The American College of Clinicians will work toward the inclusion of both NPs and PAs as full partners in the provision of primary care services. In our country's difficult time, there is tremendous potential for growth of all health care professions. We encourage all clinicians to become involved in as many ways possible to improve the health of our nation.

http://www.amcollege.org

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