Nurse Practitioner Satisfaction Levels High, But Many Overextended

Physician practices are increasingly tapping into the skills of midlevel providers such as nurse practitioners to help with growing patient loads. And in the future, this trend is only expected to continue.

The Association of American Medical Colleges predicts a worsening shortage of primary-care physicians, noted a recent article posted to the Pew Charitable Trusts' State and Consumer Initiatives website. Specifically, in the next 10 years, as one-third of all doctors retire, there will be 90,000 fewer doctors than needed to serve the nation's aging population.

The good news, according to results of a June survey from Staff Care, a locum tenens staffing company and division of AMN Healthcare, conducted at the annual American Association of Nurse Practitioners meeting, is that they're a pretty happy group of professionals. 

Nurse practitioners are considerably more satisfied than physicians: Almost all 222 of the NPs surveyed - that's 99 percent of those surveyed - said they are 'positive' about being an NP.

"We were expecting the satisfaction level to be high, but it's actually the highest level of satisfaction I've ever seen," Michelle Hoogerwerf, divisional vice president for advanced practice at Staff Care, told Physicians Practice.

Hoogerwerf notes that NPs expressed considerably more professional satisfaction than physicians, registered nurses, and other healthcare professionals AMN Healthcare companies have surveyed in the past. For example, in a recent national survey of physicians conducted by an AMN Healthcare division Merritt Hawkins, only one-third of physicians indicated they felt positively about their profession and only 13 percent said they are optimistic about the future of medicine. According to Hoogerwerf, many physicians have seen their clinical autonomy and their reimbursement declining in recent years, while many NPs have experienced just the opposite in their practices, leading to comparatively higher satisfaction rates.

However, with news of patient influxes (thanks to the Affordable Care Act), there is a possibility this could change. The majority (75 percent) of NPs surveyed said they see a shortage in their profession, and 81 percent said they are either overextended or are at full capacity. Only 19 percent said they have time to see more patients or take on more duties.

"In part of the survey we learned that nurse practitioners are feeling overextended," said Hoogerwerf.

One reason they may feel already overextended is the increase in non-clinical demands. The transition into EHRs has meant more documentation demands. A steady increase in patients also means more paperwork (or EHR documentation). Hoogerwerf says she also expects NPs will take on increasingly higher primary-care case loads.

According to the survey, NPs are averaging 44 hours per week, about one quarter of which is spent on non-clinical activities. And they're seeing about 17 patients per day.

Teri Bunker, a nurse practitioner who heads her own medical practice, Bridge City Family Medical Clinic, in Portland, Ore. -  Oregon doesn't require physicians to supervise/oversee practices - told Physicians Practice that serving an expanding Medicaid population (her practice is currently 70 percent Medicaid) will be a challenge.  

"Nurse practitioners are much more readily available and can do the same amount of stuff," Bunker told Physicians Practice. "Nurse practitioners can be cost-effective. We do tend to have longer appointment times with our patients …in specialty practices it can save a lot of money. Physicians are not going into primary care, whereas 80 to 90 percent of nurse practitioners are."