Nurse practitioners and physician assistants in primary care: An update of changes since 2008

Abstract

This article is an update to a 2008 article “Nurse Practitioners and Physician Assistants in Primary Care” which will provide not only a basic understanding of the Nurse Practitioner and Physician Assistant profession, but also developments in the professions over the last 8 years. Issues pertaining to healthcare quality, access to care, reimbursement, and increasing healthcare costs are influencing the United States healthcare system. The roles of the nurse practitioner (NP) and physician assistant (PA) in health care are crucial today in providing access to care and ensuring efficiency of care, while maintaining the quality of care given to the public. Since NPs and PAs have come into existence, they have helped with holding down healthcare costs, providing care to underserved populations, and enabling physician practices to serve their patients better. Availability of care and physician shortage became growing issues in health care. Increasing demands on physicians in terms of “intensity and complexity” of the care required began to exist. This increasing demand led to the development of these disciplines as a way to combat the challenges of health care. There are approximately 175,000 NPs and 90,000 PAs practicing in the U.S. today an increase from 100,000 and 60,000 8 years ago. Those numbers have more than doubled since 1990. In fact, according to Roblin, NP/PAs are capable of potentially seeing 50%–75% of all primary care visits. Given their track record, employing NPs and PAs in primary care settings seems like a logical choice. In all, 40% of NPs are trained as family NPs and 10% are trained in pediatrics. Other NPs are trained to specialize, unlike PAs who are always trained as generalists with half in medical offices and the other half in hospitals, public health, nursing homes, and other settings. NPs and PAs are used by approximately one-quarter of primary care physicians, seeing nearly the same types of patients as the physician. Family physicians are using NPs and PAs more than any other medical specialty. More than 60% of physician group practices are now employing NPs and