NPs And PAs Moving Away From Primary Care

Primary healthcare is inarguably one of the most important specialties of medicine because of how many people it affects on a day-to-day basis. Since the passing of The Affordable Care Act in 2010, nearly 30 million previously uninsured people now receive health care insurance, dramatically increasing the number of patients who seek treatment from primary care providers. However the number of practicing primary care professionals has not reflected this shift in the healthcare equilibrium.

The Association for American Medical Colleges predicts that the U.S. will have a shortage of 90,000 physicians in the next 10 years. What’s more, most doctors, having completed medical school, now choose to go into subspecialties, such as dermatology, optometry, etc.

Recent legislation to expand the responsibilities and services provided by nurse practitioners (NPs) and physician assistants (PAs), such as the authority to prescribe controlled substances, has been an effort to offset this shortage. This transition of primary care givers is in fact one of the key factors projected to impact the future of healthcare. And though the number of overall NPs and PAs entering the medical field is not problematic, the number of them also entering specialty care as opposed to primary care is cause for concern.

The American Academy of Family Physicians’ Robert Graham Center reported that only 42.3 percent of PAs and 52.4 percent of NPs currently work in primary care. The number of hours worked per week and overall responsibilities of the work for both primary and specialty care is generally the same for NPs and PAs. Thus the transition of so many medical professionals now opting to work in specialty care can be attributed to one key factor: money.

Jeff Levin-Scherz, M.D., M.B.A., of Harvard Medical School states that there is now a very negative perception associated with primary care, due to the low income and lack of compensation compared to specialty care. Of 10,000 individuals surveyed by the American Academy of Physician Assistants, PAs who worked in dermatology, emergency medicine and surgery had a median salary ranging from $10,000 to $20,000 more than those who worked in primary care and family medicine.

While the education and training are more intensive and time-consuming for physicians set to enter a specific specialty field of medicine, the transition into specialty care is fairly easy for PAs, who can actually switch specialties multiple times over the course of their career. And although 90 percent of NPs are specifically trained in primary care, many are able to specialize. According to Elizabeth Seymour, a family physician at the Medical Associates of Denton, Texas, “[NPs] fit in everywhere as long as it helps out the physician.”

Considering the demanding nature and heavy responsibility that comes with a job in the medical field, not to mention the increasingly high rate of burnout amongst medical professionals, it’s not terribly surprising that more financially lucrative career in specialty care might seem more appealing and worthwhile to NPs and PAs.

Levin-Scherz also claims that recent government efforts to increase the number residency programs and train more physicians, NPs and PAs, will do nothing to combat the dire lack of people working in primary care. The likelihood is that they will also choose to join the current surplus of specialty caregivers. Unless the perception primary caregivers is improved, the unfortunate stigma now associated with this category of healthcare is unlikely to go away, and will probably get worse.