Nurse practitioners, physician assistants now manage one-quarter of US health care visits
Key takeaways:
- The proportion of health care visits delivered by PAs and NPs in 1 year rose from 14% to 25.6%.
- The chances of getting care from NPs or PAs was highest among those who were disabled, rural or had lower income.
The proportion of health care visits delivered by physician assistants or nurse practitioners is rapidly increasing and now accounts for one in every four visits, according to the results of research published in The BMJ.
In the United States, the number of nurse practitioners (NPs) or physician assistants (PAs) is rising, Sadiq Y. Patel, PhD, a postdoctoral research fellow at Harvard Medical School’s Department of Health Care Policy, and colleagues wrote. In fact, from 2019 to 2031, the Bureau of Labor Statistics has estimated that the number of PAs will rise 48% from 120,000 to 178,000 and the number of NPs will jump 80% from 200,000 to 359,000.
However, until now, “quantifying the proportion of care and the type of care provided by NPs and PAs has been hampered” because of indirect billing, they wrote.
“With indirect billing, the nurse practitioner or physician assistant provides most of the care for a patient but the bill for the service is submitted under a supervising physician,” Patel and colleagues wrote. “A novel method, published in 2022, described how to identify indirect billing visits and estimated that nationally between 2010 and 2018, 44% of all NP and PA visits in the U.S. were billed indirectly. Therefore, prior research that only examines the visits directly billed by an NP or PA substantially underestimates their involvement in the U.S. health care system and conversely overestimates the involvement of physicians.”
The researchers conducted a cross-sectional time-series study using national data from the Medicare insurance program on 267 million visits that took place from Jan. 1, 2013, to Dec. 31, 2019, “to better characterize the involvement of NPs and PAs in the U.S. health care system.”
Patel and colleagues found that, in the U.S., the proportion of health care visits delivered by PAs or NPs is rapidly increasing and now accounts for about 25% of all visits.
More specifically, the proportion of health care visits delivered by PAs and NPs in 1 year rose from 14% to 25.6%. However, proportions varied across different specialties and conditions. For example, in 2019, the percentages of visits by an NP or PA were:
- 13.2% for eye disorders;
- 20.4% for hypertension;
- 36.7% for anxiety disorders; and
- 41.5% for respiratory infections.
The researchers also found that, of those who had at least one visit in 2019, 41.9% had at least one visit from a NP or PA. Also, the likelihood of receiving any care from these providers was highest among patients who were disabled (5.6% greater), had lower income (2.9%) or were rural residents (19.7%) compared with patients who had no visits from NPs or PAs.
“We believe our results provide the best available estimate of the involvement of NPs and PAs in the U.S. health care system,” Patel and colleagues concluded. “Our results highlight the rapidly growing involvement of NPs and PAs in the U.S. Future research is needed to understand the implications of this growth on the quality of care that Americans receive.”
Perspective
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The U.S. population is growing, and the population is getting older, but the physician workforce is not growing at the same rate. We know that the health care market has responded, and this study confirms that the number of NPs has increased 80% and the number of PAs has grown by 48%. U.S. medical schools have responded to the increased demand by expanding the total number of medical student slots by both increasing class sizes and actual new medical schools. However, it takes a minimum of 11 years post-high school to get a physician into the workforce, whereas the minimum amount of education to get a PA and a NP into the workforce is 5 to 6 years, respectively, thus getting these Advanced Practice providers into the health care system more quickly than physicians.
We can’t ignore the fact that the monetary layout for education and the salaries are much cheaper than those of physicians. Historically, the demographics that have had a shortfall of medical providers include populations with lower income, rural areas and those who are disabled — therefore, it makes sense that the NPs and PAs are filling that need, as demonstrated by this article. They are a valuable and necessary part of the health care team that is directed by the physician.
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