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This Week in Primary Care
The More Primary Care Clinicians #2! Issue
If we’re going to get to Primary Care for All Americans, we will need more primary care clinicians! Last issue reviewed the policy origins of the U.S. physician shortage, and highlighted ways to train more physicians and support more of them to stay in primary care. Now, we turn to the other almost half of U.S. primary care clinicians: nurse practitioners (NPs). As of 2022, NPs made up 47% of primary care clinicians– up from 19% in 2010. (2022: 270,660 NPs, 279,194 physicians, 28,282 PAs. 2010: 55,400 NPs, 205,000 full-time-equivalent physicians, 27,700 PAs.)
NP training starts with a Bachelor of Science in Nursing, continues with one or more years working as a nurse, and finishes with a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). These advanced degree programs typically last 2-3 years full time, although there are 15-18-month accelerated programs. Graduates must pass a national exam in their field of choice (65% Family, 21% Adult Gerontology Primary Care, Psych Mental Health, Pediatric Primary Care, or Women’s Health, and 12% non-primary-care fields per the American Academy of Nurse Practitioners), and can then either enter practice or optionally undertake an additional year of supervised practice.
Currently NPs can practice independently in 27 states; the remaining 23 impose restrictions on scope and/or require a formal supervisory or collaborative relationship with a physician. NPs practice in community health centers, private clinics, VA facilities, and long-term care facilities, in multidisciplinary teams or on their own. They may care for their own group of patients as a primary care clinician or share responsibility for a group of patients with other clinicians. The evidence base is still developing on what roles and team configurations in primary care support best health, at lowest cost, with a well workforce, but it is clear that nurse practitioners play an essential and growing role in getting to Primary Care for All Americans.
In this light, it is disappointing that Congress is advancing plans to cut support for nursing faculty and nursing pathways programs next year (see press release below). We should be training more, not fewer, nurses and nurse practitioners. Communities and states can create additional opportunities for postgraduate supervised clinical practice (as the VA and some federally qualified health centers are already doing), to help build skills and confidence in the transition to providing comprehensive primary care. And communities and researchers can study what roles and team configurations best support access to the comprehensive, continuous, coordinated, first-contact care that characterizes high-quality primary care.
Americans trust nurses more than any other profession, and have for over 20 years. Join us at tonight’s Teach-In/Learn-In to dig into public distrust & American medicine, with Dr. Bryant Adibe!
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TONIGHT: September 30th Teach-In/Learn-In!
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