The debate as to whether the nation is facing a physician shortage in the future is continuing. When assessing the likely adequacy of the future workforce to meet the health care needs of the nation, a critical factor to consider is the supply and availability of clinicians other than physicians who can make an important contribution to access and efficiency.
In this posting, I report updated numbers on the pipeline of nurse practitioners (NPs), physician assistants (PAs), and pharmacists. If these practitioners are fully integrated into the delivery system and allowed to practice consistent with their education and training, this growth can help assure access to cost-effective care across the nation.
The Recent Growth
The figures below use slightly different metrics to measure growth in the pipeline, but the patterns are consistent across professions: steady, strong growth.
Figure 1 presents the number of new NP graduates as reported by the American Association of Colleges of Nursing (AACN) and the National Organization of Nurse Practitioner Faculties (NONPF). Not all new NPs will go on to practice as NPs—for example, some NPs may continue in an RN position and others may go into administrative positions—but the vast majority are likely to practice as NPs.
The graduation figures reflect the significant growth in the pipeline from 6,611 in 2003 to 18,484 in 2014, an increase of 180 percent. The growth between 2013 and 2014 was strong at 15.3 percent.
Figure 2 presents the number of PAs passing the examination required for certification by the National Commission on Certification of Physician Assistants (NCCPA). Basically, all PAs that want to practice must first be certified by the NCCPA, so that organization’s data on the number of newly certified PAs is a very good measure of the pipeline.
The number of newly certified PAs went from 4,337 in 2003 to 7,578 in 2014, an increase of 74.7 percent. (2014 data from personal communication with NCCPA, April 2015). The annual number of new PAs will certainly continue to grow, as the number of accredited PA programs increased from 137 in 2005 to 196 in April 2015, and another 77 applications for new programs are currently under review. As with NPs, the growth in the PA pipeline between 2013 and 2014 was strong at 14.8 percent.
According to the American Association of Colleges of Pharmacy (AACP), the number of pharmacy graduates was 7,488 in 2003. By 2014, the number of pharmacy graduates had grown to an estimated 13,838, representing an increase of 84.8 percent from 2003 to 2014 (Figure 3). The AACP projects the number of annual graduates will grow to 15,632 by 2017. While the annual growth from 2013 to 2014 (4 percent) was not as dramatic as the growth of the NP and PA pipeline, the growth over the past 15 years has been steady and consistent.
There is no doubt that additional practitioners will be available to help meet the needs of a growing US population. Based on this data, the number of new NPs and PAs in 2014 was 26,000 and growing. This compares to an estimated 30,500 new physicians entering the pipeline in 2014.
This disparity highlights how important nonphysician providers such as NPs, PAs, and pharmacists will be in meeting our primary care and other health care needs in the future. It also highlights the importance of considering the pipeline for these providers when we assess our health care workforce needs.
* Counts include master’s and post-master’s NP and NP/CNS graduates, and Baccalaureate-to-DNP graduates.
Source: American Association of Colleges of Nursing (AACN) and National Organization of Nurse Practitioner Faculties (NONPF) Annual Surveys
* Counts include PAs passing the Physician Assistant National Certifying Exam (PANCE)
Source: National Commission on Certification of Physician Assistants “Certified Physician Assistant Population Trends ”; 2014 data from personal communication with NCCPA April 2015
* Data represents first professional degrees including B.S. Pharmacy, B.Pharm., and Pharm.D. Graduation projection figure based on enrollment data.
Source: American Association of Colleges of Pharmacy (AACP )2014 Enrollment Data