There are many different futures for the healthcare system in the United States. They range from a growing healthcare system that provides equitable, accessible, and affordable care for all, to the dismal march into greater inefficacy, costliness, and inequity that is the currently the trademark of our current last-place system.
The future of healthcare is dependent on the reform of insurance systems, policy, and education, among other aspects. As we stare down the road toward these different futures, one reality that must be faced is the impending primary care provider (PCP) shortage.
Primary care is essential to a thriving healthcare system and a healthy populous. One of the principal benefits of primary care is prevention. Prevention is good for the patient because it keeps them healthy and good for the system because it lowers the overall costs of care. It also diminishes costs associated with unnecessary or excessive medical care.
What’s more, primary care is less costly than specialist care and therefore essential to health equity. When accessible and publicized in communities, primary care has been proven to diminish health disparities between social classes.
It is evident that primary care is crucial to a healthy population and healthcare system. We must come to understand the shortage and how to help mitigate it. Keep reading to learn about how PCP shortages will impact the Northwest region of the United States, and how nurse practitioners can be a part of the solution.
Even though nurse practitioners (NPs) are considered primary care providers in many states across the U.S., the discussion of PCP shortages often focuses on doctor shortages, and the following analysis is no exception.
By 2025, the U.S. Health Resources and Services Administration (HRSA) predicts that the country will have 7 percent fewer PCPs than it needs to keep up with demand. HRSA estimates that this percentage will translate to an unfilled need of more than 23,000 PCPs in the nation’s healthcare system.
The Association of American Medical Colleges (AAMC) comes to a similar conclusion in its report. By using several different predictive scenarios, the AAMC predicts that the shortage will range between 14,800 and 49,300 PCPs by 2030. AAMC discusses the impact of utilizing advanced practice registered nurses (APRNs) and physician assistants (PAs) as a strategy to overcome the physician shortage.
According to its projection, the heavy use of APRNs and PAs in primary care roles could potentially create a PCP surplus, and even with only moderate APRN and PA use, the shortage could be greatly diminished. Whether or not APRNs can be effective in cutting through the impending shortage depends on the state in which they practice.
Although not the hardest hit region in the U.S., the Northwest is going to feel the impact of PCP shortages in 2025, with about 7 percent inadequacy, according to the HRSA. For context, the Northeast region is predicted to have a 4 percent surplus. The South (minus Washington D.C.) will have an 18 percent deficit. The Midwest is projected to have an 8 percent inadequacy, and the Southwest’s shortage is anticipated to come in at 6 percent.
In the Northwest, three states are expected to have more supply than demand: Alaska, Oregon, and Washington, at 14 percent, 3.7 percent, and 0.3 percent, respectively. Despite not being the most impacted region, four states are predicted to have significant deficits by 2025:
To learn detailed information about the projected shortages in each of these states, including how APRNs may be a way to ease the shortages, please keep reading.
At 25.3 percent, Utah is predicted to have the greatest PCP deficit in the Northwest by 2025, and the fifth most deprived state in the U.S. The HRSA predicts that Utah will see the number of PCPs grow from 1,520 to 1,770 between 2013 and 2025, a growth rate of 16.4 percent. This growth in supply will not be enough to match the growing demand.
Already at a PCP deficit in 2013, demand in Utah is predicted to grow from 1,970 to 2,370, a growth rate of 23.5 percent. Numerically, the 7.4 percent shortage translates in a PCP shortage of 600 for Utah in 2025.
In predicting how many PCPs will be needed to maintain the status quo of care in Utah, the Robert Graham Center (RGC) paints a slightly more deprived picture. Between 2010 and 2025, RGC predicts that 814 PCPs will be needed to maintain status quo care in Utah. When this prediction is extended to 2030, that need rises above 1,000, with 169 PCPs needed due to increased care utilization as a result of aging, 815 as a result of population growth, and 111 as a result of a larger population of insured citizens.
Despite having a reduced scope of practice in Utah, nurse practitioners may be one solution to the impending PCP shortage. In Utah, NPs are considered PCPs, can practice independently of a physician, and can prescribe most medications independently as well. The only limitation in their scope of practice is for Schedule II controlled substances. While an NP can eventually prescribe these substances independently after two years or 2,000 hours of practice, before this experience threshold is met, they must enter into consultation with a licensed physician.
As NPs in Utah have a great deal of independence, they may be able to help in a “heavy use” scenarios as outlined by the AAMC projections. Despite their utility, and despite the fact that the HRSA predicts there will be an NP surplus in Utah by 2025, the surplus comes in numerically at only 370. If only looking to in-state NPs to fill the PCP gap, the impact will be limited.
With an 18.5 percent predicted deficit, Idaho will be the 11th most impacted state by PCP shortages. Like Utah, Idaho is anticipated to experience growth of PCP supply, with an expected growth rate of 14.6 percent bringing the quantity of PCPs from 960 in 2013 to 1,100 in 2025. However, demand is anticipated to grow 21.6 percent during the same period, from 1,110 to 1,350. With demand outpacing supply by seven percent, the HRSA predicts Idaho will have a numeric deficiency of 250 PCPs by 2025.
The RGC paints a similar picture, predicting that between 2010 and 2025, Idaho will need to add 288 PCPs to the workforce to maintain the status quo care. Through 2030, this number will rise to 382, with 84 new PCPs needed due to aging, 258 due to population growth, and 40 due to increased insurance utilization.
In Idaho, NPs may be a large part of the solution as a result of their full scope of practice. In Idaho, NPs are recognized as PCPs and can practice independently of physicians with prescriptive authority as well. In Idaho, the HRSA predicts an NP surplus of 290 by 2025. Because NPs in Idaho have a full scope of practice, if Idaho follows the heavy use scenario as modeled by AAMC, Idaho will have enough NPs to cover the PCP deficit as predicted by both the HRSA and the RGC.
At a predicted 15 percent PCP inadequacy, Wyoming will experience a loss in PCP supply between 2010 and 2025, down to 340 from 350, a decline rate of less than 3 percent. Already at a deficit in 2013, the demand in Wyoming will grow from 390 to 400 in 2025, a growth rate of 2.6 percent. With supply failing to catch up with demand at a rate of 5.4 percent, the numeric PCP shortage in Wyoming is anticipated to be 60.
Predicting that 83 PCPs will be needed in the workforce to maintain status quo care in Wyoming, the RGC corroborates the HRSA’s findings. In 2030, this need will rise to 104, with 28 PCPs required due to aging, 64 due to population growth, and 12 due to increased insurance utilization.
Similarly to Idaho, NPs could be hugely important in overcoming the impending PCP shortage. NPs in Wyoming have a full scope of practice, meaning they are recognized as PCPs, can practice independently from physicians, and have full prescriptive authority. The HRSA predicts that by 2025, Wyoming will have an NP surplus of 60 NPs, exactly enough to overcome the PCP shortage in the state as predicted by the HRSA. If RGC’s figure is required, there will not be enough to fully overcome the PCP deficit, but enough to cover a large margin of what is needed.
The HRSA predicts that by 2025, Montana will have 6.7 percent fewer PCPs that it needs. Between 2013 and 2025, the HRSA anticipates no growth in the number of PCPs. Demand during this period will rise by 8.7 percent, bringing the need for PCPs from 690 to 750. The 8.7 percent difference in supply and demand means that by 2025, Montana will need 190 more PCPs than it can provide.
The RGC projections show that by 2025, 170 PCPs will be needed in the workforce to maintain Montana’s status quo levels of care. Through 2030, this need will rise to 197, with 53 PCPs required to due aging, 115 PCPs as a result of population growth, and 29 PCPs as a result of increased insurance utilization.
Similar to most of the states in the Northwest, NPs in Montana have a full practice authority. NPs are recognized in the state as PCPs, can practice independently of physicians, and have full prescriptive authority over Schedule III to Schedule V controlled substances. Schedule II controlled substances can be prescribed in emergency situations through a phone call to a pharmacist. Like Idaho, Montana’s predicted 190 NP surplus would be the exact amount needed to balance the HRSA’s PCP deficit, and more than enough to overcome the workforce needs as predicted by the RGC.
The Northwest provides a powerful example of a compelling strategy to ensure that citizens have access to primary care, despite the impending physician shortage. When NPs can practice primary care without barriers, the impending PCP shortages do not seem so insurmountable. Since the HRSA predicts that every state in the U.S. is expected to have a surplus of NPs by 2025, the regions that allow for greater freedom of practice for NPs have more recourse than those states who still limit the scope of practice for NPs.