If primary care is the foundation of the evolving health care system in this country, and if access to primary care for all is the goal, then nurse practitioners will be increasingly crucial to achieving these aims. Let’s face it, in our current system, there just aren’t enough primary care providers to meet the nation’s need while containing costs and focusing on quality outcomes. With an estimated 30 million more people who will be covered and require access to full primary care based on the Patient Protection Affordable Care Act (ACA) numbers, we will need additional providers functioning to their fullest preparation.
2013 National Resident Matching Program Data
The 2013 National Resident Matching Program (NRMP) released in March is not good news for primary care. Although matching rates were up overall, the primary care numbers are still very low given the national need. According to the American Academy of Family Physicians (AAFP, 2013), only an additional 92 U.S. graduate medical students were matched to primary care specialties compared to a year ago. That translates to 39 more family medicine resident positions filled, 14 more internal medicine positions, 3 more pediatric and 36 pediatric/internal medicine positions filled, compared to 2012. The bottom line is 1,916 U.S. medical school grads were matched to primary care residency programs, with a total of 3,715 primary care matches when international graduates are included (AAFP,2013; NRMP, 2013) .
Primary Care Nurse Practitioner 2012 Graduation Rates
At the same time, the 2012 nurse practitioner (NP) graduation rates announced recently by the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties (AACN/NONPF 2013) showed a continued increase in primary care. Primary care NP graduates include those prepared as pediatric, family, adult, gerontological, adult/gerontological, and women’s health NPs. They numbered 11,764 in 2012 compared to 9,708 in 2011, an increase of 18.6 percent or 2,228 NPs.
Primary Care NP graduates accounted for 84 percent of all NP graduates in 2012 whereas U.S. medical school primary care matches accounted for about 11.6 percent of the 16,390 U.S. matches. When international medical students are included, about 14.6 percent of all 25,463 matches were in primary care (AAFP, 2013; NRMP, 2013).
The difference in medical students choosing and matching with primary care specialties and NPs choosing primary care preparation is stunning. Not all NPs prepared in primary care end up in primary care; in fact, the actual rate for NPs may be about 55-66 percent (AHRQ, AANP). Not all physicians who match with primary care residencies actually end up in primary care either. Nevertheless, reliable data documents that primary care NPs are increasing in significantly larger numbers than primary care physicians and these increasing numbers of primary care NPs will have a major, mounting role in meeting the nation’s primary care needs.
NP Regulation And Barriers To Full Use Of The Limited Workforce
Costly and unnecessary barriers to NP practice continue to exist. More than half the states require physician supervision or collaboration for an NP to practice, despite the lack of any data to support the need for such a regulation. These out-of-date and unnecessary regulations waste precious physician time and in fact are not feasible, given the current and concerning shortage of primary care physicians.
NP preparation is already regulated by national nursing education competencies and standards and national accreditors approved by the Department of Education. It is time to move forward and allow every health care professional to practice to their fullest preparation as recommended by the Institute of Medicine in two recent reports (IOM, 2011, Future of Nursing and IOM 2012, Geographic Adjustment Factors for Medicare, Second Report), the Josiah Macy Foundation’s report on Primary Care (2010) and the recent National Governors Association report on the role of NPs in meeting the nation’s primary care needs (NGA, 2012).
The need to address the primary care physician shortage is also critical. There is no joy in the very small growth of medical students choosing to match with primary care specialties. Complex issues are related to those decisions that cannot be ignored or minimized. But removing the barriers to NP practice in every state is one important step to maximize our existing primary care workforce. The inability of NPs to practice to the full extent of their education is simply a waste of valuable resources for helping to meet the nation’s primary care needs.
When all providers work to their fullest capacity and view collaboration as a professional ethic rather than a pointless mandate, we can begin to better address the burgeoning primary care needs of our citizens. The truth be told, quality primary care is by its nature collaborative whether physicians or NPs are the provider. No one discipline can do it all.