Can Nurse Practitioners Fill The Primary-Care Hole?

Spring has arrived, and hope is rising that the United States might finally be on the verge of universal health coverage. But, as many observers have pointed out, access to health insurance is not the same as access to health care. Massachusetts, for example, has achieved near-universal coverage; but because of a shortage of primary-care physicians, only 52 percent of internists were accepting new patients in 2008. A new study by physician recruiting firm Merritt Hawkins & Associates, similarly, shows that Boston has the longest wait times to see a physician among 15 U.S. cities. On average, Bostonians wait 70 days to see an ob/gyn and 63 days to see a family physician. Nationally, the number of physicians going into primary care keeps declining, and a shortage of 44,000 primary-care providers is forecast by 2025.

Are “nurse-managed health centers” run by nurse practitioners the answer? They could be, said participants at a recent Washington, DC, conference organized by the American Academy of Nursing. University of Miami President and former HHS Secretary Donna Shalala said that these organizations deserved more federal funding. And Pennsylvania Gov. Ed Rendell cited the success of his “Prescription for Pennsylvania” program, which has enlisted non-physician clinicians to provide primary care in underserved areas.

“Greater nurse practitioner involvement in chronic care and rapid response is the inoculation we need to prevent rising heath care costs and ensure greater access to heath care,” said Rendell.

Tine Hansen-Turton, executive director of the National Nursing Centers Consortium, pointed proudly to the nation’s 250 nurse-managed health centers, which she defined as “community-based, non-profit health centers that are staffed and run by advanced practice nurses (primarily nurse practitioners). They represent an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations.”

There’s only one problem: the supply of nurse practitioners is not large and is increasing very slowly. While there were about 115,000 active NPs in 2004, the number of new NPs graduating from training programs was declining by 4.5 percent each year, according to the Center for the Health Professions. Today, there are only 125,000 practicing NPs, the American Academy of Nurse Practitioners says. Of those, about 65 percent work in primary care. By 2015, the total number of NPs in primary care is projected to be 100,000. Meanwhile, more and more NPs are employed by retail clinics, which supply only a narrow range of services.

It’s a fine idea to supplement the dwindling workforce of primary-care physicians with mid-level practitioners. But until we can figure out how to enlist and train more of them, the primary-care shortage will continue growing. And even if we could flood America with NPs, they’re no substitute for physicians.

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