The year is 2043 and Maria waits patiently in the receiving pod for her primary care provider. The cool blue light is on, indicating scanners are continuously monitoring her vital functions. Her measurements display on the virtual wall to her right. Maria notes that her blood pressure is reading a bit high at 150/85.
Maria needs to see an orthopedic surgeon for her worsening hip problem but national healthcare resource utilization guidelines issued back in 2030 as part of the Healthcare Reform Act prohibits patients from self-referring to specialists; only Nurse Practitioners (NPs) can authorize consults to medical specialists. In 2043, there are no primary care physicians; NPs provide all of the nation's primary care and medical schools only graduate specialists, such as surgeons and neurologists.
Evelyn, Maria's NP, enters the pod with a shy appearing young man deferentially trailing behind, "Maria, this is Dr. David. He's in the final year of his medical residency. I'm supervising his clinical rotation. Would you be OK with him joining us?"
"Sure", said Maria. She's used to medical residents in the office. Evelyn is a well-renowned clinician and medical residents line up to have her as a preceptor.
"Maria, don't worry. I'm sending you for a multiplex InstaTran full body scan. It'll be wirelessly transmitted so I can view it right away and we can go from there. David, can you please make sure the scan is ordered, notify my colleague, Dr. Narang, and let's schedule her for a re-check on her blood pressure?"
What is the employment future of primary care NPs? Will they be in demand, supplying the bulk of primary care services, as the vignette suggests?
Nursing schools, graduating increasing numbers of NPs every year, with thousands more in the pipeline, seem to think so. Is this an indicator of future need or are schools riding the "Now" train? Can the job market sustain the rapid growth?
Forecasting the supply and demand of healthcare practitioners is difficult. One thing we do know is that NPs in primary care have a projected growth rate higher than that of other registered nurses with graduate-level degrees such as certified registered nurse anesthetists and certified nurse midwives .
It's generally believed that there is a shortage of NPs and that the shortage will continue. But a recent report by the U.S. Department of Human and Health Services (DHHS) Health Resources and Services Administration (HRSA) says otherwise. HRSA predicts an oversupply of NPs.
By the year 2025, there will be an estimated 110,540 full-time equivalent (FTE) primary care NPs. This is close to twice the number of FTE primary care NPs in 2013 and almost double the projected 2025 demand.
Even though there are geographic disparities in the distribution of primary care NPs, every state, plus the District of Columbia, is predicted to have an oversupply. No state is predicted to have a shortage of NPs by 2025.
Florida alone is estimated to have 7,640 FTE primary care NPs by 2025- but the projected demand is for 3,120. Similarly, Tennessee is estimated to have 3,100 NPs- with a projected demand of only1,400.
How did HRSA arrive at the numbers? HRSA used a Health Workforce Simulation Model (HWSM) to calculate state level and national projections.
Future supply and demand was estimated by taking into consideration:
- Population growth
- Aging baby boomers
- Expanded health coverage
- Changes in health care reimbursement
- Geographic location
- Workforce participation
- Retirement
HRSA also looked at the projected supply and demand for primary care physicians and Physician Assistants (PAs). While the supply of NPs and PAs is predicted to outpace the demand, the supply of primary care physicians will grow more slowly than the demand, with an overall national shortage that masks regional and state-level variations.
With a focus on wellness and disease prevention, it stands to reason that NPs are in a key position to ease the burden of the physician shortages and provide access to effective primary health care. Nurses are being recognized as key members of healthcare.
Perhaps the projected oversupply will turn into a much-needed opportunity for NPs to assume more primary care roles. It would be good for NPs and good for the health of our nation.
Resources
NP Fact Sheet. (2016). American Association of Nurse Practitioners. Accessed April 2017 from AANP - NP Fact Sheet
Bodenheimer, T., & Bauer, L. (2016). Rethinking the Primary Care Workforce-An Expanded Role for Nurses. New England Journal of Medicine, 375(11), 1015-1017.
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2016. State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. Rockville, Maryland.
