July 11, 2011 — Advanced practice nurses (APNs) and physician assistants (PAs) are frequently touted as the solution to the physician shortage, but there will not be enough of all 3 professionals combined to meet the nation's healthcare needs in 2025, according to a study published in the June issue of the Journal of the American College of Surgeons.
Lead author Michael Sargen, a medical student at the University of Pennsylvania in Philadelphia, and coauthors write that although the United States needs to expand the workforce of these 3 types of "advanced clinicians," healthcare personnel with less training must assume more patient care responsibilities, especially as more Americans gain insurance coverage under the Affordable Care Act.
Right now, the nation fields close to 300 advanced clinicians for every 100,000 Americans. That number is roughly 7% less than needed, based on the demand for services, which the authors extrapolate from healthcare spending. The authors write that if training programs for PAs and APNs — which include nurse practitioners — grow as currently projected while physician residency programs fail to expand, the per capita supply of advanced clinicians in 2025 will resemble the current level.
However, the workforce of 2025 in this scenario will be 20% less than needed because of burgeoning demand for services. The authors cite government studies that forecast a 65% increase in healthcare spending from 2009 to 2025 based on its historic growth rate of 2.5% above the growth of the gross domestic product (GDP).
The healthcare reform law aims to reduce that growth rate to 1% above GDP, the authors write, but even if reformers hit this target, demand for services will still outstrip the supply of advanced clinicians.
Coauthor Richard Cooper, MD, an authority on physician workforce issues and a professor at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, chalks up the continued rise in spending not only to costly technologies but also to the sheer proliferation of new therapies.
"Research is finding ways to treat diseases that were once untreatable," Dr. Cooper told Medscape Medical News. "We once didn't treat lung cancer. Now we do. We don't treat Alzheimer's disease now, but we will in the future."
"Everyone Should Work to Their Level of Education"
A 20% shortfall in the advanced-clinician workforce in 2025 is the study's worst-case scenario. The nation will more likely face a 15% shortage that year, the authors write, given the pressure to add more first-year slots to residency programs.
The study authors mention several wild cards that were not factored into their analysis but that could aggravate the shortage. Physicians, they write, are working fewer and fewer hours. And all clinicians are increasingly pulled away from patient care by chores such as documenting what they do for the sake of getting paid. These factors could increase unmet demand for advanced clinicians by an additional 10% to 15%, according to the authors.
Wild cards aside, even under the rosiest scenario for advanced-clinician head counts, the nation still "must broaden the spectrum of healthcare workers who can assist in delivering services," write the authors. That means advanced clinicians must learn to delegate responsibilities that can be performed by personnel with less training and to focus on the services that only they can provide, Dr. Cooper told Medscape Medical News.
"Everyone should work to their level of education," he said. "This is easy to talk about when you work in a hospital with a lot of people [to delegate to]," he said. "It's more difficult when you're a solo practitioner."
The need to spread out the work, he predicts, will drive more physicians to join larger, more organized systems, such as hospitals and large group practices.
The authors have disclosed no relevant financial relationships.
J Am Coll Surg. 2011;212:991-999. Abstract
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