Since the passing of the ACA, the healthcare workforce has
dealt with an immense influx of newly insured patients requiring medical
attention. It is estimated that 32 million people will be newly insured by 2019
as a result of the ACA (Carrier, Stark, & Yee, 2011). There is a gross
inadequacy in professional healthcare worker distribution across different
healthcare settings which may leave our nation ill-prepared for this new
patient population. The biggest discrepancy exists in the fact that specialists
outnumber general practitioners by nearly two to one (Barton, 2010). Whereas
this trend is supported by the increased reimbursement rates received by
specialists, it actually negatively affects the healthcare workforce by
encouraging the emergence of specialists when in reality generalists are more
direly needed. The ACA attempts to make up for these discrepancies by
establishing incentives for primary care practitioners. An estimated $3.5
billion was invested by the ACA into the primary care provider bonus from
2011-2016, in which Medicare paid a 10% bonus over the established physician fee
schedule for general care provided by primary care physicians, nurse
practitioners, clinical nurse specialists, or physician assistants practicing
family medicine, internal medicine, geriatrics, or pediatrics (Stone &
Bryant, 2012).
One
way in which primary care practices have been making up for this shortage of
physicians is by utilizing physician extenders such as advanced nurse
practitioners and physician assistants. The increasing independence and scope
of practice of these midlevel providers also make these healthcare
professionals a valuable resource that may help increase access to primary
care. These midlevel providers often perform duties which overlap with those of
physicians, including assessment, diagnosis, and treatment of patients, and
both practice with “considerable clinical autonomy” (Morgan, Short, &
Strand De Oliveira, 2011). Whereas the utilization of these midlevel providers
in combined workforce planning appears to be part of the solution to the
physician shortage, it has met several barriers in practice. These barriers
include “lack of data on some professions, professional interest in protecting
turf, competing agendas, and entrenched habits of state bureaucracies and
professional organizations” (Morgan, Short, & Strand De Oliveira, 2011).
In
the state of Florida, these midlevel providers have not yet achieved “full
practice” status. Currently 21 states and the District of Columbia have granted
nurse practitioners such freedom. In those full-practice states, NPs can treat
patients independently, as well as open their own practices without physician
supervision (Simmons, 2015). One crippling limitation on the nurse
practitioner’s scope of practice in Florida is that she cannot prescribe
controlled medications, and for that reason only physicians can see patients
with complex mental health or behavioral issues in our pediatric primary care
practice. Reimbursement rates for services rendered by midlevel providers are
80% of the physician fee schedule. However, considering the fact that these midlevel
providers’ salaries are approximately half that of a physician, as well as that
there are many more midlevel candidates than physician candidates applying for
positions, hiring midlevel providers may be one of the best solutions to
combating the current shortage of primary care physicians and increasing
patient access to care. Additionally, areas that have shortages of primary
care, dental, or mental health providers are designated as Health Professional
Shortage Areas (HPSA) by the Health Resources and Services Administration
(HRSA). Practices in those designated HPSA areas can qualify as National Health
Service Corps (NHSC) sites, and healthcare providers employed by them then
become eligible for student loan forgiveness. Our site is a designated NHSC
site, and we have a great advantage in recruiting midlevel providers seeking
loan repayment.
In
conclusion, efforts must be made to encourage the education of more general
practitioners, be they physicians, physician assistants, or nurse
practitioners. The demand for these general healthcare professionals will only
increase, and we need to be well-prepared to provide these services to the
growing patient population. By involving midlevel practitioners in workforce
planning and utilizing them at the peak of their education and productivity,
physicians will be freed from these duties and therefore will be made available
to tackle more complex cases which require their extended physician education
and expertise. It is therefore crucial that the remaining states, including
Florida, that have not yet granted midlevel providers “full practice” status
reevaluate their decisions in order to increase patient access to greatly
needed quality medical care.
Leading Management Solutions helps medical
practice leaders identify ways to improve operations to increase revenue,
employee engagement, and patient satisfaction. Learn more about us at www.lmshealthpro.com.
About the Author:
Sonda Eunus is the Founder and CEO of
Leading Management Solutions, a healthcare management consulting company (www.lmshealthpro.com). Along with a team
of experienced and knowledgeable consultants, she works with healthcare
practice managers to improve practice operations, train employees, increase
practice revenue, and much more. She holds a Masters in Healthcare Management
and a BA in Psychology.
