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Change is occurring in the U.S. Healthcare system. There is a continued shortage of healthcare providers across the United States. However, this lack of health professionals is occurring as new models of healthcare delivery are emerging. These new delivery models are pushing to maintain a high quality of patient care, while simultaneously lowering overall healthcare cost. One solution to these challenges is to hire and expand the role of nurse practitioners (NP) in the American healthcare system. In fact, many states are currently doing this by expanding the number of licenses and certifications for nurse practitioners.

When compared to physicians in many states, nurse practitioners are increasingly in demand, particularly as more states provide NPs with direct access to patients. A 2018 study from the American Association of Nurse Practitioners (AANP) has found that there are nearly 248,000 licensed nurse practitioners nationwide. This is an increase from 2007, where there were about 120,000 nurse practitioners across the country. By 2026, the Bureau of Labor Statistics (BLS) predicts that the profession of nurse practitioners will grow by 36%. Similarly, the profession of physician assistants is projected to increase by 37%. However, the growth in physicians (excluding anesthesiologists and surgeons) is predicted to only be 13%. As of 2017, the five U.S. states highest employment level of NPs was California, New York, Texas, Florida and Ohio.

An estimated 77.8% of all NPs deliver primary care. There is a shortage of doctors in primary care which is a complex issue with many causes. Yet, this physician shortage has likely helped to increase the demand for nurse practitioners. Large retail clinics like CVS Health and Walgreens have already shifted to the use of NPs. Many of these retail clinics are already staffed by nurse practitioners who treat routine maladies. Urgent care centers, outpatient clinics and doctor’s offices also staff nurse practitioners in primary care roles. Even among psychiatrist and other mental health professionals, NPs are seen as a possible option. The National Council for Behavioral Health has advocated that one solution to the shortage of behavioral health practitioners is to employ physician assistants with psychiatric training. NPs are able to provide quality primary care, yet some observers are concerned that the patient care may drop. But, the modern emphasis on team-based health care makes nurse practitioners an ideal candidate for filling gaps in healthcare delivery due to the physician shortage.

To clarify, nurse practitioners have not been universally chosen to fill the need for a greater number of clinicians. There is considerable variability with the extent to which nurse practitioners are allowed to operate at the top of their licensure. Some states have fairly lenient autonomy policies, meaning nurse practitioners in those states have more autonomy are able to fill in for physicians. In these states, the physician shortage is seen as a supply and demand issue, with nurse practitioners seen as a potential solution to the problem. For example, Accountable Care Organizations (ACOs) are using nurse practitioners and advanced practice registered nurses (APRNs) to meet the needs of their patients. ACOs take on a certain amount of risk for their patient populations, meaning that keeping patients out of high-cost care encounters is essential to their mission. Nurse practitioners are seen by ACOs as having a more holistic medical approach, which may better align with the goals of an ACO.

However, critics have argued that nurse practitioner care is not sufficient enough to cover the complex care needs of certain patient populations. In 2016, when the VA considered granting full treating autonomy to nurse practitioners to close some care gaps, the American Medical Association asserted that an interdisciplinary team led by a doctor was the most effective means by which patients can receive treatment. Researchers agree that physicians bring tremendous value to any healthcare team or system. All patients deserve access to a physician’s deep medical expertise.

Nurse practitioners can deliver connected, relationship-based care as well as a real knowledge of disease, pathophysiology and treatment modalities. As the healthcare industry continues to focus on population health management and overall patient wellness, the role of the nurse is slated for continuous growth. This is especially true as the nation’s general population ages and a greater demand is placed on the healthcare system. As healthcare continues to focus on population health management and overall patient wellness, the role of NPs will continue to grow.

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Nurse Practitioners, Growing Demand