Physician assistants and advance practice nurses
Question
Read this paper and write a one page summary of it. Then reorganize this paper so it flows together better. It should be a 8-10 page paper when completed.
Answer
Contents
Career and Labor Market Information for Advanced Practice Professionals. 7
Projections for Future Needs of Practitioners. 7
Introduction
Access to quality and reasonably priced health care remains a major national and global target. For this to be achieved there is a need to equip healthcare facilities with well trained and motivated caregivers. This paper will discuss and analyze advanced practice healthcare professionals, primarily Physician’s Assistants (PAs), and Advanced Practice Nurses. These professionals are vital to the healthcare industry for many reasons and have dramatically impacted the quality of patient care that is practiced in private clinic settings and hospitals. Each area of specialty contributes significantly to the industry and those who pursue these professions are highly regarded for their knowledge and expertise within the field.
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The healthcare industry is highly susceptible to the fluctuating political, economic, and social climate. Notable political policies like the Affordable Healthcare Act, government insurance: Medicaid and Medicare, and an aging baby boomer population have created both incentives and further demands, on an already burdened healthcare system. This influence is especially visible the delivery of primary care. Over the past few years, the healthcare system has experienced a steady decline in physicians entering primary care. This has been due to both the need for more specialized care and the financial incentive to practice specialized medicine. This shift, as well, as the increased demand for primary care providers has created a gap that physician’s assistants and nurse practitioners have bridged (Naylor & Kurtzman, 2010).
Healthcare professionals in advanced practice include Physician’s Assistants and Advanced Practice Nurses. A Physician’s Assistant “is a nationally certified and state-licensed medical professional. PAs practice medicine on healthcare teams with physicians and other providers. They practice and prescribe medication in all 50 states, the District of Columbia, U.S. territories, and the uniformed services (AAPA.Org, n.d). Advanced practice registered nurses are composed of nurse practitioners, certified nurse midwives, nurse anesthetists and clinical nurse specialists (Nursingworld.org, n.d). Depending on their area of specialty, APRNs can provide a wide range of advanced services, to include: performing physical exams, diagnosing and monitoring acute or chronic disease processes, monitoring anesthesia or obstetric/gynecological services. Patient care, diagnosing and other advanced capabilities are no longer limited to physicians only, which is quite an evolution from where medicine began. It is encouraging to see so many career options available for those interested in joining the healthcare industry. These career opportunities represent a rapidly-evolving field that demands highly trained professionals in order for patient needs to be adequately met and continued advances in medicine & technology.
A physician assistant is a nurse who is a licensed medical professional and who works with physicians and all other healthcare providers. The physician assistants (PAs) practice medicine in all the states of the United States as well as in the armed forces. Their importance to healthcare is vital as they are involved in many services that include leading patient-centered medical teams and combining with other healthcare experts to give the best healthcare services available. Also, the PAs are experts in medicine as they must pass a certification exam to be accepted to offer healthcare services (AAPA, n.d.). The services offered by PAs cannot be underestimated as they can treat and prescribe medicine to sick people. Furthermore, studies have shown that the PAs are the most trusted health professionals.
The PAs are the healthcare officers that interact most with the patients in the hospitals. Many of them obtain jobs in the most profitable hospitals in the United States after graduation and after their initial licensing and certification exams. After the enactment of the Affordable Care Act in 2010, the PAs were recognized, and this increased their stake in the health sector. According to statistics, more than 300% of the PAs were employed between the year of 2011 and 2015, highlighting their importance (AAPA, n.d.).
The educational qualifications to become a PA are a master’s degree from an accredited institution in the United States. The nurses are taught how the assessment, diagnosis, and management of problems relating to patients are done and also which medicines to prescribe. In addition to the degree, the PAs should possess a license that will enable them to work in the specific state where they want to work. As of May 2016, the annual pay of a physician assistant was $101,480. It is projected that the growth rate for the jobs of physician assistants will grow tremendously over the next ten years (U.S. Bureau of Labor Statistics, 2017 a). The assistants will independently provide care for the patients.
Another important role that the AP nurses play in healthcare is their involvement in preventative care. Other types of advanced practice nursing include the Certified Nurse Practitioner, the Clinical Nurse Specialist, the Certified Registered Nurse Anesthetist and the Certified Nurse-Midwife (National Council of State Boards of Nursing, [NCSBN], n.d.). In each of these categories, nurses have a highly specialized role in practicing the type of health care required by the patients. The certified nurse practitioners are trained to an advanced level where they have the ability to offer care to patients independently. Some of the roles the nurses are involved with include health promotion, prevention of disease, education related to health as well as counseling. Also, they work to diagnose and manage acute and chronic diseases (NCSBN, n.d.).
The nurses deal with pediatric patients, family practice, women’s health, community health, and the geriatric population among others. Clinical nurse specialists have training that is at the same level as that of certified nurse practitioners and across the continuum of care. Furthermore, the nurses work in caring for the patients in one of the six described populations. The primary role of the nurses is working in the healthcare facility that involves patient care, nursing practice and a health organization where they are employed (NCSBN, n.d.). The nurses are accountable for diagnosis and treatment of the health or illness states and disease management. Moreover, the nurses ensure that there is health promotion, illness prevention in individuals and the control of risk behaviors in families and communities.
The certified registered nurse anesthetist is involved in providing care for patients suffering from anesthesia and anesthesia-related conditions. The patients who suffer from these conditions may have severe or life-threatening illnesses. The care is provided in special rooms that are included in the hospital surgical suites. The certified nurse-midwife is concerned with providing health care to women across the lifespan. The care provided by the nurses includes gynecologic care, childbirth, family planning services, preconception care, prenatal and postpartum care among others. Also, the nurses may treat men for sexually transmitted diseases as well as give advice on reproductive health at a request from their female partners (NCSBN). The places where the nurses provide their care range from homes, birth centers, hospitals, and ambulatory care settings. Other places are community settings as well as public health clinics.
Currently, advanced practitioners make up a sizeable portion of primary care providers and that number is expected to grow. “Physician assistants and nurse practitioners provide a substantial amount of primary care. A previous study found twice as many nurse practitioners (18.9%) as physician assistants (10.3%) among primary care providers” (Park, Cherry and Decker, 2011)..This increase in AP’s creates special concerns for advanced practitioners and both the state and federal government. According to Naylor & Kurtzman(2010), despite licensing and credentialing required by the federal government, individual states vary widely on the restrictions and limitations placed on nurse practitioners
Similarly, despite the federal government having a framework for certification and educational requirements to practice independently as an advanced care practitioner, states are able to restrict and control AP’s autonomy. State imposed restrictions limit and control NP’s scope of care and create a fluctuating and irregular supply of AP’s directly linked to how restrictive state imposed sanctions are. States that heavily restrict and regulate advanced care practitioners have notably lower numbers of NP’s that are available to provide care to populations in need. Not only do state restrictions vary significantly, but government third-party payers like Medicare and Medicaid compensate AP’s differently than traditional MD primary care providers.
Factors like the types of care provided and the type of facility the care is provided in, also, create a barrage of restrictions that create unnecessary hurdles for NP’s. In some cases, NP’s can only charge a percentage of what a physician would charge for the same type of exam or service. Hein and Fleck (2014) contend that many NPs report that payer polices have a significant impact on their ability to practice to the fullest extent of their licensure and training. There are also varying restrictions on diagnosing capabilities amongst advanced practitioners. AP’s are sometimes forced to send out a patient to a licensed MD’s for the same exam that was administered, only to validate their diagnosis. This method is both inefficient for the patient and the provider, not to mention costly and repetitive (Safriet, 2002).This system undermines advanced care practitioner’s effectiveness and their ability to fully exercise their abilities.
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The federal government already has a framework of educational requirements that delineate precisely what is required to practice as an advanced practitioner. Instead of state and counties being able to set their own guidelines and restrictions, uniformity across the states should be mandatory. This could mean higher availability of primary care providers for patients and a standard of care that patients can rely on. One of the biggest concerns with the explosion of advanced care practitioners is that it would lead to a deterioration in the quality of healthcare. However, statistics illustrate that this is far from accurate. More relaxed restriction does not equate to lower quality care. It is important to note, that studies demonstrate that there is no disparity in outcomes for patients for AP’s (Davis, Abrams and Stremikis, 2011).It is important that these special needs and concerns are addressed with the need for Advanced Practitioners only expected to grow.
Recent politics has also had a significant impact on primary care. The Affordable Care Act made having health insurance mandatory and ensured that American’s across the country now had health insurance. More patients meant more demand on the healthcare system. However, the ACA also sought to address some of the issues already plaguing our system like the shortage of primary care providers. One of the main reasons that physicians have been gravitating away from primary care is the lack of profitability. Other factors like more need for specialized care must be accounted for, however, the reality is that medical school is not a cheap education pipeline and there is little financial incentive in primary care. Advanced care practitioners have stepped in and filled the shortage; however, the health system needs more primary care providers. The ACA makes provisions to once again incentivize primary care. The ACA now allows the federal government to provide more compensation, scholarships for education, and a larger portion of the federal budget to revitalize primary care and better compensate advanced care practitioners (Page, 2013).
Career and Labor Market Information for Advanced Practice Professionals
Physician’s Assistants: According to the US Bureau of Labor and Statistics, median salary for PAs in 2016 was $101,480, with nearly 100,000 PAs employed across the US in 2014 and an projected increase in job outlook of 30% (higher than average) by 2024 (Bureau of Statistics, 2016 a). Advanced Practice Nurses: Per the BLS, APRNs earn a median salary of $107,460 annually. In 2014, the number of jobs for this field was 170,400. By 2024, the projected increase in job outlook for this profession is 31% (higher than average) (Bureau of Statistics, 2016 b).
Each profession described above has a higher than average projected market growth and above-average salaries, which is encouraging for candidates interested in pursuing either field. The educational requirements, which will also be discussed in depth, are modest in comparison to the starting salaries for both fields. Though physicians earn higher salaries, the career outlook for doctors is roughly half that of PAs and APRNs in addition to extensive educational requirements, internships and residencies. For candidates interested in the ability to practice medicine, treat patients and hold responsibilities similar to those of a physician, either of these careers are viable options.
Projections for Future Needs of Practitioners
Healthcare needs are consistently rising in the US and many physicians are electing to pursue specialty medicine. This leaves significant openings in the area of primary care, which can be addressed by both PAs and nurse practitioners. With a progressing focus on preventative medicine in our country, primary care providers are vital to ensure the health and well-being of patients. Hospitals and private clinical settings are likely to pursue PAs and APRNs as alternatives to physicians, as it is more cost effective to hire a PA or nurse practitioner than a physician. Physician’s salaries are roughly twice that of a PA and APRN – an important value to note when considering overall expenses for a healthcare facility.
Similarly, APRNs are essential for both preventative and specialty care. With the rising expense of healthcare, many facilities are focusing on allocating resources and analyzing the need for more physicians or if certain roles can be replaced with support staff such as APRNs or physician’s assistants. From a cost savings perspective, there is significant financial gain to having one supervising physician oversee PAs and APRNs rather than being fully staffed with physicians, without the concern for compromise of patient care. This cost savings can impact the facility’s ability to offer enhanced services or update equipment, which is essential for a field that is consistently evolving technologically.
As outlined above, advanced practice professionals are in high demand and the demand for quality candidates will only continue to increase as healthcare needs become more intricate and advances in medicine are made. In addition to the obvious financial benefit to hiring advanced practice professionals, the US will face a shortage of nearly 90,000 physicians by the year 2025. While medical school enrollment is on the rise, there has not been an increase in available residency programs which can limit a physician’s ability to complete their training5. This identifies a clear area of need that qualified individuals such as PAs and APRNs can readily address. As more states recognize these professions and expand on the duties that PAs and APRNs can provide, the demand for each will only continue to increase.
According to the Medical School Enrollment Survey, there will be more than 30% enrollment of physicians and advanced nurses into the Universities and other institutions of higher learning. The increase is to address the current crisis of lack of physicians and nurses that the country faces (Association of American Medical Colleges, 2015). With the implementation of the Affordable Care Act, many physician assistants and advanced nurses are required to take care of the older people, who are the main beneficiaries of the Act. This way, they will be adhering with the proposed Act, as a way of implementing the act or rather practicing it; they should always give old people the best care irrespective of their position in the society. In a nutshell, assistant physicians and nurse practitioners play a crucial role in maintain the balance in the health sector. Not only do they fill the gap that result from the shortage of physicians but also provide vital primary health care. There is need to address the myriad of challenges that face them such as differential state restrictions to ensure uniformity.
References
“Advanced Practice Nurses”. (n.d.). Retrieved from http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses
“Medical School Enrollment to Approach 30 Percent Increase by 2019”. (2015). Retrieved from https://www.aamc.org/newsroom/newsreleases/431036/20150430.html
“What is a Physician’s Assistant?”(n.d.). Retrieved from https://www.aapa.org/what-is-a-pa/
AAPA. (n.d.).What is a PA?Retrieved 17 May 2017, from https://www.aapa.org/what-is-a-pa/
Association of American Medical Colleges. (2015). Medical school enrollment to approach 30 percent increase by 2019” – News releases – NewsroomRetrieved 17 May 2017, from https://www.aamc.org/newsroom/newsreleases/431036/20150430.html
Association of American Medical Colleges. (2015). Medical school enrollment to approach 30 percent increase by 2019” – News releases – NewsroomRetrieved 17 May 2017, from https://www.aamc.org/newsroom/newsreleases/431036/20150430.html
Davis, K., Abrams, M., & Stremikis, K. (2011). How the Affordable Care Act Will Strengthen the Nation’s Primary Care Foundation. Journal of General Internal Medicine, 26(10), 1201–1203. Retrieved from http://doi.org/10.1007/s11606-011-1720-y
Hain, D. & Fleck, L. (2014) “Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing, 19(2), Manuscript Retrieved from http://www.nursingworld.com
National Council of State Boards of Nursing. APRNS in the U.S. (n.d.)Retrieved 17 May 2017, from https://www.ncsbn.org/aprn.htm
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Page, L. (2013). “8 Ways the ACA Is Affecting Doctor’s Income”. Medscape. Retrieved from http://nejmcareercenter.org
Park, M., Cherry, D. &Decker, S. (2011). Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants in Physician Offices. NCHS Data Brief No. 69. Retrieved from htpp://www.cdc.gov
Safriet, B. (2002). “Closing the Gap Between Can and May in Health-Care Providers’ Scope of Practice: A Primer for Policymakers”. Faculty Scholarship Series. Paper 4422.
Retrieved from http://digitalcommons.law.yale.edu/fss_papers/4422
U.S. Bureau of Labor Statistics. (2017). Occupational Outlook Handbook, 2016-17 Edition, Physician Assistants. Retrieved from https://www.bls.gov/ooh/healthcare/physician-assistants.htm.
U.S. Bureau of Labor Statistics. (2017). Occupational Outlook Handbook, 2016-17 Edition, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. Retrieved from https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse- practitioners.htm