Government Report Shows Increase of Nurse Practitioners in Primary Care

After declining for two decades, the rate of recently licensed nurse practitioners (NPs) joining the primary care workforce is moving upward, according to a new report from the Health Resources and Services Administration (HRSA).

According to the National Sample Survey of Nurse Practitioners, in 1992, 59 percent of graduating NPs worked in primary care, but that decreased to 42 percent between 2003 and 2007. The new survey, based on 2012 data, shows that 47 percent NPs who graduated since 2008 have entered primary care, Nurse Zone reports. Survey results also showed:

• 94 percent of that total NP workforce held a graduate degree in some field, 86 percent had a master’s degree in nursing, and 5 percent held a doctoral degree in nursing;
• 76 percent of the NP workforce maintained certification in a primary care specialty (family, adult, pediatric, or gerontology); and
• More than half of the NP workforce worked in ambulatory care settings, with nearly a third practicing in hospitals.

Two recent studies funded by INQRI found significant benefits of NPs working in primary care. The first, led by Joanne Spetz at the University of California, San Francisco, found that increasing use of retail clinics in which nurse practitioners provide primary care and practice independently, can dramatically reduce health care costs, as much as $810 million in 2015, if those clinics account for 10 percent of outpatient primary care visits.

The other, led by David Auerbach of RAND and funded in part by the Donaghue Foundation, found that increasing the number of and the use of models of health care delivery that rely on nurse practitioners or physician assistants as primary care providers could offset the expected primary care physician shortage in 2025.

New Human Capital Blog Post Regarding the Shortage of Primary Care Providers

A recent issue of the New England Journal of Medicine features two examples of policy analysis focused on the implications of expanding nurse practitioners' scope of practice relative to primary care, as well as an editorial addressing the same. Dr. Linda H. Aiken, a member of the INQRI National Advisory Committee and a Research Manager supporting the Future of Nursing: Campaign for Action, discusses these pieces in a new blog post on RWJF's Human Capital blog.

Click here to read Dr. Aiken's post and share your comments.

How Nurses Are Solving Primary Care Challenges

"In the area of primary care, economic and demographic pressures have driven innovation. Many such breakthroughs focus on the roles of nurses, many of whom are leading an evolution in the delivery of primary care. Nurse practitioners and certified nurse midwives, for example, make up a growing portion of the primary care workforce. Meanwhile, RNs and licensed practical nurses are increasingly tracking patients to make sure they get the care they need. In addition, nurses at several levels are managing chronic conditions and coordinating care transitions."

Check out the Robert Wood Johnson Foundation's latest edition of Charting Nursing's Future which details the ways that nurses are stepping up to solve primary care challenges across the country.

Solving Many of the United States' Primary Care Challenges

With the Affordable Care Act being upheld earlier this summer, there will a large flux on individuals with insurance coverage that require primary care. As many of our previous blog posts have already discussed, there is already a primary care provider shortage and this shortage is expected to grow even further after 2014.

The most recent Charting Nursing's Future, published by the Robert Wood Johnson Foundation, highlighted how nurses can help solve many of primary care’s most pressing challenges, including access and cost.

Gene Steuerle, writing for his own blog, The Government We Deserve, also focused on the role of nurses in reducing costs while providing the same level, or even better care than physicians for many basic services. Mr. Steuerle, who is a renowned economic and tax expert, argued that the current primary care provider shortage is a result of an uncompetitive industry unwilling to relinquish control over services that many non-physicians have the training and education to provide.

Finally, a collaborative group of scholars published a thorough article in the New England Journal of Medicine, highlighting how our health system can reduce costs while improving care. The utilization of nurses and other allied health professionals was highlighted by the authors as an integral piece of reforming our broken health system.

Report: Higher Payments Are No Cure For Doctor Shortage

Earlier this week, Jordan Rau, reporting for Kaiser Health News, detailed a recent report by the Institute of Medicine that recommended that Medicare should not raise reimbursements to lure practitioners to rural areas. The panel of experts suggested that instead of raising reimbursements, Medicare should provide payment for the use of telemedicine, in addition to supporting the expansion of scope of practice laws in restrictive states. By promoting the use of advanced practice nurses, the IOM believes it is possible to close the primary care physician gap using the existing workforce and network of resources currently available.

To read more about the report, click here.

The American Medical Association’s President-Elect on the Future of Health Care

Over the weekend, Sarah Kliff, reporting for the Washington Post's Wonkblog, interviewed Dr. Ardis Hoven, the president-elect of the American Medical Association (AMA). We decided to share this interview with all of you as Ms. Kliff brings up pertinent workforce issues that directly address scope-of-practice with Dr. Hoven that yield insight into how the AMA views future collaboration with nurses and other health care personnel.

Access Ms. Kliff's interview with Dr. Hoven here.

Sharp Increase Expected in Number of Nurse Practitioners

According to a study published in the July edition of Medical Care, the total number of trained nurse practitioners is expected to grow 94% from 128,000 in 2008 to 244,000 in 2025. The research, led by health economist David I. Auerbach, PhD, also found that there will be a significant growth in the number nurse practitioners providing direct care, which will rise 130% from 86,000 in 2008 to 198,000 in 2025.

To read more about this Dr. Auerbach's research, click here.

To read the full-article, click here (subscription required).

Counting on Nurses to Fill New Jersey's Primary Care Gap

During the holiday break, Patricia A. Barnett, Chief Executive Officer of the New Jersey State Nurses Association & Institute for Nursing, wrote an editorial that detailed how allowing nurse practitioners to practice to the full extent of their training will ease the upcoming primary care shortage plaguing New Jersey. The suggestions made by Ms. Barnett align with the recommendations made by IOM's Future of Nursing: Leading Change, Advancing Health report, which seek to bolster the nursing field while improving health care in the United States.

Click here to read Ms. Barnett's editorial.

Click here to read all blogposts relating to the IOM's report.

Nurse Practitioners Fill a Gap in Rural Health Care

Over the weekend, Robert Joiner, a staff writer for the St. Louis Beacon, discussed how the demand for advanced practice RNs is expected to rise due to the projected growth of patients in need of primary care. The article also explained in concise detail the concern over advanced practice nurses' scope of practice restrictions, as well discussing how many of the reccomendations made in the IOM's Future of Nursing: Leading Change, Advancing Health report can improve care delivery.

Click here to read the article.

Click here to read other blogposts discussing the IOM's report.

Remembering Joyce Clifford

A little over a week ago, Joyce C. Clifford, PhD, RN, FAAN, a respected nurse researcher and colleague of many INQRI grantees, passed away at age 76. Dr. Clifford advocated a partnership of equals between doctors and nurses in the treatment of patients, and introduced the "primary nursing" model in 1975 at Beth Israel Hospital in Boston.

Yesterday, Paul Vitello, of the New York Times, wrote a fascinating piece detailing the accomplishments Dr. Clifford achieved throughout her respected career.

Click here to read the story.

The Role Of Nurse Practitioners In Reinventing Primary Care

INQRI director Mary Naylor and Ellen Kurtzman have a new piece in the May 2010 edition of Health Affairs, "The Role of Nurse Practioners in Reinventing Primary Care."

"Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary care and reducing more costly health resource use. We recommend that nurse practice acts—the state laws governing how nurses may practice—be standardized, that equivalent reimbursement be paid for comparable services regardless of practitioner, and that performance results be publicly reported to maximize the high-quality care that nurse practitioners provide."

Click here to read the article.