This year, the Affordable Care Act enabled millions more Americans to gain insurance, and in doing so, accelerated the demand on a healthcare system already stretched too thin. It is against this backdrop that the use of locum tenens, nurse practitioners, and physician assistants continues to become more prominent. Here's a closer look at each of these roles, how they are changing, and what that means for medical practices.
Using a locum has become the "go-to" for filling in scheduling gaps, ramping up during peak periods, and as a temporary solution during a search for a new physician.
The majority of physicians who practice locum tenens are either early career or nearing retirement. However, more physicians in the middle of their careers are deciding to practice locums as well, taking advantage of its flexibility in an effort to sustain their work/life balance, experience travel opportunities, pay off debt, and practice medicine without having to deal with the politics that come with permanent positions.
While both practices and providers are taking advantage of the benefits locum tenens physicians provide, skeptics argue that their increasing utilization is a symptom of a system with core issues yet to be solved. Most notable is the pronounced lack of providers choosing primary care, a lack of access to care in rural areas, and an inadequate amount of residency slots.
The rise of NPs and PAs has been impressive. These providers are increasingly emerging as a solution to the aforementioned healthcare industry shortcomings, and their respective national associations continue to work as strong advocates for more legislation to provide them a higher level of autonomy.
However, physician advocates have responded to both associations with suggested restrictions instead, most often citing reasons surrounding patient safety within primary care. Most recently, physician advocates have battled advanced practitioners in at least eight states calling for reform laws.
Even with the ongoing debate with physicians over scope of practice, the demand for NPs, specifically, is sharply increasing. The majority of NPs are currently in primary care; however, they are also being utilized in more settings and specialties than before. This includes roles in critical care and first assist. Their foundation in nursing can be a valuable asset in the ICU.
According to the American Association of Nurse Practitioners, 19 states and the District of Columbia now allow NPs to treat and prescribe independently. Another 19 allow them to practice semi-independently, requiring some type of physician agreement, such as when they are prescribing painkillers. Other states such as Kentucky, Connecticut, New York, Minnesota, along with the Department of Veterans Affairs, have eased restrictions in 2014 on their ability to prescribe common drugs , such as blood pressure medication, or medications prescribed in behavioral health settings. Twelve states previously considered most restrictive are now also considering similar proposals.
PAs, while still growing in use and compensation, are not seeing as much expansion in scope of practice as NPs. PAs can prescribe in all 50 states, but they also require supervision, and have a more defined role. For subspecialists in a surgical setting for instance, PAs are utilized for pre- and post-operative functions. Many PAs practice in emergency departments, in outpatient offices, participate in hospitalist rounds, and serve in first assist roles.
What's coming in 2015
Over the coming year, expect the use of locum tenens, NPs, and PAs to continue to increase. In addition, more regulations regarding scope of practice and prescribing authority for NPs and PAs are likely to be revised as their national associations continue to debate physician advocates in state legislatures.
Practice administrators, fellow providers, and practice managers will continue to discover how locum tenens, NPs, and PAs best fit within their staffing plans, enabling them to meet patient expectations of timely quality care, while achieving revenue goals.
Mike Gianas is the director of communications with Consilium Staffing. He may be reached at [email protected].
This article originally appeared in the November/December 2014 issue of Physicians Practice.