Can Non-physicians Clinicians Help Combat the Looming Physician Shortage?

Can Non-physicians Clinicians Help Combat the Looming Physician Shortage?

As the U.S. is facing a physician shortage, industry experts are mulling the role that nonphysician clinicians can play in filling the health care gap.

MTS Transcription Services United States

It’s real and quite unfortunate – there is a physician shortage in the U.S. According to a 2017 press release from the Association of American Medical Colleges (AAMC), the nation faces a projected shortage between 40,800 and 104,900 physicians over the next decade.

As a socially-responsible medical transcription company serving all medical specialties, we are concerned about the risk that physician shortage poses to patient care access. Experts are suggesting that non-physician clinicians (NCPs) could help close the gap, though this view is not endorsed by all. Let’s take a look at the varying views on the question of whether NCPs can help combat the looming physician shortage.

The Role of the Non-physician Clinician NPCs refer to nurse practitioners (NPs) and physician assistants (PAs). NPCs are defined as health professionals who provide services that would otherwise be provided by physicians.

The American Association of Nurse Practitioners defines a nurse practitioner as a nurse who has completed a master's or doctoral degree program, and who has advanced clinical training beyond their initial professional registered nurse preparation. The American Academy of Physician Assistants defines a physician assistant as a graduate of an accredited PA educational program who is nationally certified and state-licensed to practice medicine with the supervision of a physician.

NCPs work in collaboration with physicians, or under the supervision of physicians, to improve the quality, range and/or quantity of medical services. NCPs play an important role in the health workforce. A report published by the National Conference of State Legislatures (NCSL) discusses various studies which suggest that targeted expansions of scope of practice for NCPs can enhance access to primary care services and care quality and cut certain types of costs.

-

A study by the Institute of Medicine (IOM) found that NCPs play a significant role in providing care to people in underserved areas, especially in rural America. The study reported that NCPs increased access to care, and can reduce hospitalization and rehospitalization rates for elderly patients.

-

Studies have found that NCPs spend more time in consultation with patients, which improved patient satisfaction and quality of care.

-

In Massachusetts, visits to nurse practitioners and physicians assistants cost 20 percent to 35 percent less than visits to physicians, according to a 2009 RAND study

www.medicaltranscriptionservicecompany.com

(800) 670 2809

According to a 2011 Kaiser Family Foundation (KFF) report, 84 percent of nurse practitioners have a master’s degree in nursing, and 4 percent have PhDs in their field. KFF notes that “NPs take medical histories, provide complete physical examinations, diagnose and treat acute and chronic illnesses, provide immunizations, prescribe and manage medications and other therapies, order and interpret lab tests and x-rays, and provide patient education and supportive counseling.”

PAs are also well educated, with 40 percent holding a bachelor’s degree in their field and 43 percent holding a master’s degree. PAs generally function as part of a physician-led team and provide diagnostic, therapeutic, and preventive care services under physician supervision.

Industry experts maintain that NPCs’ high level of education makes them well qualified to provide patient care and that NCPs can fill the physician shortage care gaps, especially in primary care. They are calling for greater autonomy for NCPs. Physician Concerns A 2014 Medscape article reported that many physicians are concerned about the increasing dependence on NCPs. The article cites a 2013 survey by Deloitte which found that 55 percent of physicians believe that primary care services will be delivered by nonphysicians over the next decade, and 65 percent thought that increased dependence on nonphysicians can negatively impact the quality of care. Here’s what some physicians had to say about the role of NCPs:

-

NPs and PAs are "not interchangeable" with doctors

-

Physicians are still superior in differential diagnoses of new patients

-

It is possible that NPs and PAs may order more tests because they may be less sure of their diagnoses – though there is no proof of this

-

NPs can treat basic medical conditions such as uncomplicated hypertension, asthma, and high cholesterol, but primary care also involves less obvious problems

Physician Shortage Crisis Augmented by Growing Older Population AAMC experts say that population growth and the influx of older patients are worsening physician shortages. The population of older patients over age 65 is expected to grow by 55

www.medicaltranscriptionservicecompany.com

(800) 670 2809

percent by 2030, which will increase the need for better population health and chronic disease management. The growth in the older adult population in the rural areas and the shortage of rural physicians will increase demand for primary care services. Physician shortages will lead to patient appointment scheduling delays and longer wait times. This will have negative health consequences and lower patient satisfaction. The three main medical disciplines most affected the healthcare provider shortage areas are dental health, primary care, and mental health.

The Road Ahead According to the AAMC press release, by 2030, the U.S. population of Americans aged 65 and older will grow by 55 percent. This makes the projected shortage even more troubling as older patients need two to three times as many services, especially specialty care, where physician shortages are particularly severe.

In recent years, states have taken several actions to expand the scope and standards of practice for non-physician primary care providers. According to the NCSL report, the states continue to look into how NCPs can play a larger role in providing primary care in rural areas. Policymakers also opine that the role of NPs and PAs should be better defined. NPs and PAs can take care of the less challenging cases and primary care physicians should be freed up to perform the tasks that only physicians have been trained to perform. NCPs usually refer complicated cases to specialists.

To help ease the physician shortage, the AAMC recommends a multipronged solution, which involves expanding medical school class size, innovating in care delivery and team-based care, making better use of technology, and increasing federal support for an additional 3,000 new residency positions per year over the next five years. The American Medical Association has developed an interactive map highlighting physician shortage areas to help medical students decide where to begin their careers.

Our medical transcription company will continue to provide dedicated documentation solutions to help providers focus on care and improve patient satisfaction.

www.medicaltranscriptionservicecompany.com

(800) 670 2809