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An article in The New York Times said what many in medicine have known for years: PAs and NPs can be a solution to the physician shortage.
A recent article in The New York Times (NYT) caught my eye. It was one of the many articles, studies, and learned opinions that's pointed out what we in medicine have known for years. That is the healthcare system in the United States is not producing enough physicians, and for that matter, physician assistants (PA) and nurse practitioners (NP), to meet the day-to-day healthcare needs of our citizens.
While I can only speak to PAs, I’m quite sure the growth of the NP profession has been in response to that age old need, as well as a logical expansion of what is known as nursing practice. History is rich with health care providers who aren’t physicians serving the needs of their communities, and the PA profession is a logical evolution and progression of that trend. I’m relying heavily on the detailed timelines found on the PA History website in this blog. The modern era started with US Surgeon General, Leroy E. Burney, who in 1959 identified a national shortage of medically trained personnel to provide basic medical services.
This was bolstered by an address to the American Medical Association (AMA) by AMA trustee Charles Hudson, MD, where he called for what he termed a “mid-level provider” to be formed from the ranks of former military corpsmen and medics. Attempts prior to this to develop clinical nursing programs and PA programs were not successful.
In 1964, Eugene A Stead Jr., MD, petitioned Duke University to consider starting the first PA program. The next year, both the NP and PA professions began to take formation. Duke University began training 4 former Navy hospital corpsmen, and Henry K. Silver, a pediatrician, established a pediatric nurse practitioner program at the University of Colorado.
In that period of transition, many informally trained providers like PAs and NPs experienced push back that highlighted the need for enabling legislation. On the day identified at “National PA Day” in the US, the first class of formally trained PAs graduates from the Duke University PA program on Oct. 6, 1967. Since that day, the PA profession has grown rapidly, and evolved considerably, about which I have written extensively in this blog over time.
The observations in the NYT article are no surprise and nothing new. There has been a physician shortage for many decades. The Association of American Medical Colleges predicts that there will be a shortfall of 46,100 to 90,400 physicians by 2025, with a projected shortfall of 12,500 to 31,100 in family practice alone.
According to the NYT article, the U.S. has fewer practicing physicians that many comparable countries in the world. This is made worse by a system that is just not training physicians fast enough. The gist of the article, and the controversy that was made evident in the comments section, was the Institue of Medicine (IOM) report that suggests that the healthcare system isn’t undermanned -- it is inefficient. The authors of the report felt that in many primary care settings, PAs and NPs are just as efficient and effective as physicians.
This is when the fun began. The comments came in on many sides of the issue. There were a number of comments in the vein of “a PA or and NP” can never replace a physician. This despite decades of experience, and studies which show that PAs and NPs deliver a high level of care to the physician standard, and most of the time which is indistinguishable from a physician’s care when it comes to quality and outcomes.
While it did trouble me that many physicians seek to identify me as a less than optimal solution to a serious shortage of human resources in the U.S. healthcare system, I have practiced for 35 years and am use to it. What troubled me more is the lack of a better idea from my physician colleagues (at least among those commenting on this article) to deal with the very real and critical problems in the system, not the least of which are the lack of providers themselves, especially in medically underserved areas.
The reality is that PAs and NPs are an effective solution to many of the problems facing the healthcare system in American, and they can be trained more cost-effectively and faster than physicians. Speaking for PAs, I can assure my physician colleagues that I recognize the gulf in training and clinical experience between physicians and PAs, but the fact remains that PAs and NPs are well trained, efficient and effective health care providers, and well accepted by virtually all patient populations. Only working together can we make progress in solving the healthcare shortages that define our current health care system in America.