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 Nationwide, primary care doctors outnumber nurse practitioners (NPs)
by a wide margin, with almost 244,000 physicians in this field as of
2016 compared with about 123,000 NPs in primary care. That's up from
about 226,000 doctors and 59,000 NPs providing primary care in 2010.
But the primary care physician workforce is flatlining. From 2010 to
2016, the number of available doctors declined by 0.02 for every
100,000 people in the U.S. population while the number of working
nurse practitioners increased by three for every 100,000 people.
On average, the nation's largest metropolitan areas added 2.9 more
nurse practitioners than doctors for every 100,000 residents and
rural communities added 4.3 more nurses than physicians.
Rural and poor communities have long suffered from a lack of access
to primary care providers as well as specialists, shortages that
have been tied to a variety of health disparities, researchers note
in JAMA.
"The growing NP supply in these areas is offsetting low physician
supply and thus may increase primary care capacity in underserved
communities," said lead study author Ying Xue of the University of
Rochester School of Nursing in New York, in an email.
To assess the primary care workforce, researchers examined U.S.
census data as well as data on the physician workforce from the
American Medical Association, plus Medicare billing records on
doctors and nurses providing primary care.
During the study period, the average number of nurse practitioners
in communities with the most low-income residents rose from 19.8 to
41.1 for every 100,000 people, while the average number of
physicians dipped from 52.9 to 52 for every 100,000 people.
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Over that same time, the average number of nurse practitioners
serving rural communities rose from 25.2 to 41.3 for every 100,000
people, while the average number of physicians dropped from 59.5 to
47.8 for every 100,000 people.
The study doesn't show whether or how shifts in the primary care
workforce might directly impact the accessibility, affordability or
quality of care. And it wasn't designed to explain why the
proportion of doctors and nurses working in primary care is
changing.
"This study doesn't answer whether or not an NP is a good substitute
for a physician in the population overall and for any given
patient," said Dr. Anupam Jena of Harvard Medical School and
Massachusetts General Hospital in Boston, in an email.
Some previous research suggests that doctors and nurse practitioners
can provide similar quality primary care, said Jena, who wasn't
involved in the study. Some patients with complicated medical issues
that are difficult to diagnose may want to see physicians, but
research to date hasn't offered a clear picture of whether doctors
are better than NPs for these individuals, Jena added.
"Ultimately, if patients feel that their care needs aren't being
met, it's time to switch providers, whether that be from or to a
doctor or NP," Jena said.
SOURCE: http://bit.ly/2CYakDA JAMA, online January 8, 2019.
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