INQRI Brief: Non-Physicians Can Address Primary Care Shortage

A pending primary care shortage may be best addressed by implementing promising strategies that fully utilize non-physician health care professionals in new systems of care, according to a new research brief co-authored by INQRI Co-Directors Mary Naylor and Mark Pauly with Janet Weiner.

With approximately 30 million people expected to gain coverage through the Affordable Care Act (ACA), demands on primary care services will no doubt grow. The brief, Primary Care Shortages: It’s More Than Just a Head Count, examines how the ACA will affect the delivery of primary care, and reviews recent research on the primary care shortage and possible strategies to address it.

The brief outlines several strategies that show promise for addressing these demands. Among them is ACA’s investments in health professional education and training to increase the number of primary care providers, including nurse practitioners and physician assistants. Other models, like retail clinics could ensure that more people can access primary care services, particularly in rural areas.

Ultimately, allowing health care providers to practice to the full extent of their education and training is central to increasing access to primary care, the authors write.

An article on the brief from RWJF’s December 2014 Sharing Nursing’s Knowledge is available here.

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.

Research Grants Awarded to Study Nurse Residency Programs, Scope of Practice, Primary Care Workforce

The Robert Wood Johnson Foundation and INQRI today announced the recipients of four new grants from the Future of Nursing National Research Agenda. The grants will support research into key issues being addressed by the Future of Nursing: Campaign for Action: nursing education and scope of practice regulations.

A fifth study funded last year, to determine the how emerging models of primary care will affect future primary care workforce needs, is nearing completion.That study was co-funded by the Donaghue Foundation. It's being conducted by David Auerbach of the RAND Corporation.

The other four studies are:

• A team from the University of Pennsylvania will examine the impact of the provision of the Prescription for Pennsylvania law that removed practice barriers for APRNs. The research team will evaluate the development and architecture of the bill, and the success of the provision in expanding access to health care, particularly in medically underserved communities.