Nurse Practitioners to Take Increasing Role in Healthcare

A new report predicts that nurse practitioners (NPs) will likely provide a growing amount of healthcare services as demand increases during implementation of the Patient Protection and Affordable Care Act (PPACA), informally known as Obamacare.

Researchers at RAND Health (Boston, MA, USA) , identified a total of 6,798 NPs who were noted as having completed NP training by the US National Sample Survey of Registered Nurses between 1992 and 2008. They then designed an age-cohort regression-based model that was applied to the current and historical workforce, using it to forecast trends in future years, assuming stable age effects and a continuation of recent cohort tendencies. The model has been previously applied to the registered nurse and physician workforces and is robust to fluctuating enrollment trends.

The model predicted that that the number of full-time NPs will increase to 244,000 in 2025, up from 128,000 in 2008, based on modeling for population sizes and ages. Using lower and higher modeling scenarios, the growth ranges from 227,000 to 268,000 NPs in 2025. However, although the growth in numbers of NPs has been steady since 1992--at approximately 6,000 per year-- the age structure has been steadily changing over the years. The percentage of NPs older than 50 years doubled, from 22% in 2000 to 44% in 2008. However, that percentage is expected to plateau during the next few years, to decrease to about 36% in 2021, and then to start to rise again. The study was published in the July 2012 issue of Medical Care.

“When we redefine NPs as those working in nursing and who consider their position title to be 'NP,' the workforce grows from 86,000 full-time employees in 2008 to 198,000 full-time employees in 2025, representing a higher rate of growth (130%) than that seen in the default forecast,” concluded study author David Auerbach, PhD. “Although large numbers of NPs will retire in the coming decade, new cohorts of NPs are entering the workforce in ever larger numbers and appear poised to more than offset the retirements.”

The projections have three main implications for healthcare. First, recent forecasts have projected that physician shortages could reach as high as 90,000 physicians in the coming decade, and the ratio of physicians to NPs could fall from 5:1 to 3:1 overall, and from 4.1:1 to 2.3:1 in primary care in 2025. Second, if the mix of primary care providers shifts toward a higher ratio of NPs to physicians, transitional difficulties could develop as healthcare practices work to define and clarify new roles to achieve optimum team performance. Third, quality of care has to be considered, although previous research has concluded that in practices in which NPs have provided care in place of physicians, the quality of care has been similar or better.

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