The Supply of Primary Care Physician Assistants and Nurse Practitioners in Underserved North Carolina

Abstract

In the debate about a pending physician shortage it is timely to turn policy attention to the effect that the growing supply of physician assistants (PAs) and nurse practitioners (NPs) will have on physician workforce projections. The only comprehensive national data set on the nursing workforce in the United States is the National Nursing Sample Survey and data from that survey reveal that the number of NPs in the US has more than tripled over the past 20 years, increasing 223% from 15,443 in 1980 to 49,876 in 2000.1 Nationally, the number of PAs in practice has grown 354% over the same period from 8,916 PAs in 1980 to 40,469 in 2000.2 By contrast, during the same period, the number of physicians in the US increased 47%, from 519,000 in 1983 to 761,000 in 2001.3 Data from North Carolina tend to mirror these national workforce trends. Since the early 1990s, the growth in physician supply has been modest compared to that of NPs and PAs. Between 1990 and 2003, the ratio of physicians to population increased 26%, while the ratio of PAs and NPs to population increased 132% and 214%, respectively. Much of the growth of NP and PA supply has been in rural and underserved areas of the state. For every 100 physicians practicing in a county designated as a whole county persistent health professional shortage area (PHPSA) in 2003, there were 20 NPs, a substantial increase from 1990 when only 7 NPs per 100 physicians were practicing. Similarly, 21 PAs for every 100 physicians were practicing in whole county PHPSAs in 2003, up from 7 per 100 physicians in 1990. This increase in NP and PA supply relative to physicians in counties that consistently face difficulties recruiting health professionals suggested that a considerable portion of primary care in North Carolina is provided to patients by NPs or PAs.4 National data supported this supposition. Findings from an analysis of the 1995-1999 National Ambulatory Medical Care Surveys indicated that approximately 25% of primary care office-based physicians use PAs and NPs and that both are more greatly utilized in rural areas.5 Although a few studies have cited the growing supply of NPs and PAs relative to physicians, little research exists specifically on the supply and distribution of primary care PAs and NPs on the state level. The difficulty in estimating the percentage of NPs and PAs engaged in primary care has hindered attempts to model the primary care workforce, particularly in nonmetropolitan areas. Nationally, approximately half of all PAs report a primary care specialty.6 In North Carolina, 41% of PAs and 56% of all actively practicing NPs report a primary care specialty. This brief report focuses on the supply, geographic distribution, and specialty and employment characteristics of primary care NPs and PAs in North Carolina, with a specific focus on rural and health professional shortage areas. The Abstracts and Brief Reports section publishes short, focused communications on a research endeavor relevant to PA education or behavior. Submissions should be limited to approximately 1,500 words and one or two exhibits (tables or illustrations). The intent of this feature is to promulgate new information and provide a platform for additional research. Authors desiring to contribute to Abstracts and Brief Reports should forward submissions (with a copy to journal staff at jpae@PAEAonline.org) to: