Advanced practitioners increase their role in kidney care
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Advanced practitioners have gained considerable ground this past year in their profession, such as the following:
- a recent Gallup poll found nurses are the most trusted professionals;1
- US News and World Report’s “Best Jobs” report selected physician assistants (PAs) for their top job pick with nurse practitioners (NPs) as number 3;2
- Merritt Hawkins, a recruiting firm for physicians and advanced practitioners, announced that for the first time in 27 years, NPs were the most sought-after category, replacing family practice physicians who have held that spot for 14 years;3
- the U.S. Bureau of Labor Statistics expects employment growth for PAs to be 37% and for NPs to be 28% in the next 10 years;4 and
- more than one-third of physicians in a survey said more than half their patient encounters could be handled by PAs or NPs. Physicians working alongside advanced practitioners (APs) said APs spend more time with patients, are better at coordinating care and enjoy more work-life balance.5
Why are NPs and PAs moving into the “most recruited” category?
US News ranks jobs by criteria that include good pay, challenges the worker, allows room for advancement, are in demand and provides a satisfying work-life balance. Tom Florence, president of Merritt Hawkins, said, “NPs are coming into their own in a market that puts a premium on easy access to care and cost containment.”6
Practice patterns
Changes in practice patterns require the practitioner to easily transfer from one specialty to another and to be able to pivot to where help is needed and wanted. This has been important during the COVID-19 pandemic when many facilities put elective surgeries on hold and often converted hospital beds to ICU units. The PA/NP generalist training allowed them to reinvent themselves within the hospital or outpatient clinics. COVID-19 and other market forces have changed the dynamics of physician and PA/NP recruiting.
PAs and NPs are often used to staff urgent care centers and outpatient clinics, as well as provide telehealth services. This move away from primary care practice is attributed to younger patients who prefer alternatives to the traditional primary care setting. This also means a softening demand for PCPs. Only 18% of Merritt Hawkins’ search engagements were for PCPs, down from 20% in 2020 and 22% in 2019.3
Diversified caregivers
What do these announcements all have in common? It seems that the rest of the medical profession is learning what nephrology has known for many years: NPs and PAs are educated, versatile and able to pull their weight in many situations. Within nephrology, APs have been integrated into practices at all levels.
Nephrology incorporated PAs and NPs into practices in early 2004 when billing regulations opened up for APs.7 Every year since 2013, Salsberg and colleagues have highlighted the workforce issues for the American Society of Nephrology with the caveat that the present pipeline of nephrology residents and fellows will be unable to manage the volume of kidney patients.
In 2020, for nephrology fellowship match, 469 positions were offered but only 62% were filled, out of 325 applicants.8 They have documented the integration of APs into the nephrology workforce in the last15 years.9
Every 2 years, the National Kidney Foundation’s Council of Advanced Practitioners (NKF/CAP) carries out a survey of job descriptions and sites of practice for nephrology APs.10 Data in the last decade, from 2008 to 2018, showed the PAs and NPs are working in research, interventional nephrology, inpatient and outpatient dialysis, chronic kidney disease clinics, telehealth and the hospital, including regular floors and ICU.
As has been the trend for the last decade, more than 90% of APs cover patients within dialysis units. However, increasingly, there has been a move to use the APs in the hospital for the most ill and complex kidney patients. Research done by Davis and colleagues showed PAs and NPs have the ability to manage the complicated kidney patient in conjunction with nephrologists.11
We have yet to see the full impact of the pandemic. As we complete the second year of this tough time in health care, we greatly appreciate the APs who have risen to deal with the challenges that we face daily. We mourn with the families who have lost loved ones; we mourn with clinics that have lost staff members and patients; and we remember and thank the patients who have placed their trust in us.
PAs and NPs are in nephrology and indeed in other areas of medicine to stay, and we are committed to providing high-quality, compassionate and evidence-based care to our patients.
- References:
- www.beckershospitalreview.com/nursing/nurses-the-most-trusted-professionals-in-america.html. Published Dec. 23, 2020. Accessed Sept. 6, 2021.
- https://money.usnews.com/careers/best-jobs/rankings/the-100-best-jobs. Published Jan.12, 2021. Accessed Sept. 6, 2021.
- Merritt Hawkins Permanent Placement Services, www.merritthawkins.com. Published January 2021. Accessed Sept. 6, 2021.
- www.aapa.org/news-central/2019/11/pas-tied-for-7th-on-list-of-fastest-growing-professions/. Published Nov.15, 2019. Accessed Sept. 6, 2021.
- www.kpcareerplanning.org/prd/include/pwc-hri-top-healthcare-issues-2015.pdf Price Waterhouse Coopers. Published December 2014. Accessed Sept. 6, 2021.
- https://www.modernhealthcare.com/operations/nurse-practitioners-most-recruited-providers-survey-finds. Published Aug. 9, 2021. Accessed Sept. 6, 2021.
- Zuber K, et al. Clin J Am Soc Nephrol. 2019;doi:10.2215/CJN.01600219.
- Lederer E, et al. ACKD. 2020;doi10.1053/j.ackd2020.07.007.
- www.asn-online.org/education/training/workforce/Nephrology_Workforce_Study_Report_2014.pdf. American Society of Nephrology. Published 2014. Accessed Sept. 8, 2021.
- Davis J, et al. Neph News Issues. 2016; Sep;30(10):7. PMID: 30512272.
- Davis J, et al. JAAPA. 2021;doi:10.1097/01.JAA.0000723944.52480.d8.
- For more information:
- Chigozie Uko, DNP, APRN, FNP-C, is a nurse practitioner for Georgia Nephrology in Lawrenceville, Georgia. She can be reached at cuko@ganephrology.com.
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