Lisa P. Shock, MHS, PA-C
President/CEO Utilization Solutions in Healthcare, Inc
First published on Med Monthly Magazine
Physician Assistants (PAs) and Nurse Practitioners (NPs) are skilled medical professionals who play an integral part in health care delivery. Especially in primary care, PAs and NPs attract and manage a significant following of patients, especially in rural communities. Recruitment is challenging in more underserved areas, however, retention is often more important as practices and patients invest in an individual with the hope that they will stay and practice for a considerable amount of time.
In the 1960’s studies began to indicate we would not have enough primary care physicians, particularly in rural areas. As primary care demands grew, so did the demand for primary care PAs and NPs. As physician specialties were “stressed” by a flat supply but increasing demand, opportunities grew for extenders not only in primary care, but across more specialties as well.
Cooper et al (see reference 1) projected “provider shortages” in the range of 150,000 to 200,000 by 2020. The AAMC (American Association of Medical Colleges) predicts a shortfall of “91,500” by 2020. NP & PA programs have not been able to ramp up and fully supplement the decreasing physician supply (in this case provider supply) even when you add in the increasing numbers of PAs & NPs in training.
A recent 2011 Physician Retention Survey by the American Group Medical Association (AGMA) shows that the turnover rate for nurse practitioners and physician assistants is 12.6 percent, more than twice the combined, adjusted physician turnover rate of 6 percent.
So how do you attract a great PA or NP to your practice?
Obviously a PA or NP who is passionate about your clinical need is important. Highlighting the type of duties you need performed as well as the type of patient population is critical to the messaging. For example, don’t just say family practice PA/NP wanted in Xyz town, NC. Instead, say: Dynamic PA/NP wanted for charming rural underserved area in Xyz, NC. Interested providers will be responsible for health care delivery to an appreciative population that has limited resources. Medicare and Medicaid credentialing are a must.
Suburban, rural and smaller practices all have the same complaint that they cannot recruit to their area because they cannot pay as much in salary as their competition. However, often these groups are missing the mark as they often qualify for loan repayment within the state, or they might offer flexibility within a clinical work schedule that is appreciated by the provider. For example, if a PA/NP lives in town where they work, it might be agreeable that they can leave at 3 to pick up a child from school and then come back to wrap up the clinical day. Such flexibility is not easily achievable in a larger hospital or health system. Highlighting those “extras” will be important as you list all the reasons why your office is a great place to work.
At the community level there remains a Physician and PA and NP shortage. How will educational programs meet the demand? In 2012, 17,000 Physician Assistant student applicants are estimated to be competing for 5,550 seats nationwide. There is a significant proliferation of PA programs all across the country, and North Carolina is no exception, with 7 programs currently accepting applications and up to 11 are projected to matriculate students by 2014.
You can help by encouraging and supporting clinical providers to precept students. Ensuring quality health care education for learners is critical to the success of this overall system expansion. All of us currently in established clinical roles gained valuable and critical raining and experience from our teachers and clinical preceptors.
Redesigning teams to include increased numbers of primary care providers, not just physicians but also PAs and NPs, is a significant part of the solution to alleviate the well-known shortage in primary care. Improving utilization of Physician Assistants (PAs) and Nurse Practitioners (NPs) will be an integral part of the primary care delivery solution. Often, the addition of a PA/NP to a medical practice offers enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients.
Read more here:
Cooper, Richard A. New Directions for Nurse Practitioners and Physician Assistants in the Era of Physician Shortages. Academic Medicine, Vol. 82, No. 9 / September 2007.