Anticipated shortfall of primary care physicians in 2025 of between 12,500 to 31,100 unfilled vacancies. (The Complexities of Physician Supply and Demand: Projections from 2013 to 2025 March 2015)
This shortfall is caused by a growing and aging population and increased participation in the U.S. healthcare system.
While the number of medical school enrollments has increased by 6.2% (up to 52,550 enrollments in 2015, the last year data is available according to the AAMC RAE as of 9/28/2015), the number of residency openings available for primary care physicians (including general and family practice, general internal medicine, general pediatrics, and geriatric medicine) has only increased by 1% (up 42 positions in 2016 compared to 2015). These openings represent only 14.5% of the residency positions offered (American Academy of Family Physicians’ 2016 Match Results for Family Medicine). So despite increased medical school admissions, the growth in primary care specialty positions is not keeping pace with demands.
One mechanism often suggested for addressing this shortage is to increase the scope of practice of certain non-physician providers. The idea is to allow nurse practitioners (NPs) to practice independently, without direct physician oversight. If an NP is permitted to open his or her own primary care practice and provide a “first line of defense” practice to patients in a medically underserved area, physicians in that area will be free to focus on patients who require a physician’s expertise. These NP practices would deal with basic healthcare maintenance, such as treating allergies, colds/flus, and minor bumps/bruises as well as providing renewals for certain prescriptions. The argument for this increased scope of practice for non-physician practitioners is rooted in the need to increase the quantity of healthcare services available.
The counterargument is usually that an increase in practice scope for non-physician providers puts a great deal of pressure on those practitioners to correctly identify complex or borderline cases that require referrals to a physician. Practitioners who have not achieved the same degree of training as that of a physician may not have the necessary expertise to catch those cases. This argument is based on the quality of care provided to patients.
Following a national trend that has slowly emerged since 2013, West Virginia and Florida recently passed legislation loosening restrictions on certified registered NPs seeking to establish their own primary care medical practices. In these states, as in many others, the efforts to increase healthcare access while maintaining quality of care warrant close scrutiny in the coming years to determine if these efforts are ultimately successful.
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