The appointment with a nurse practitioner has become a standard component of primary care for numerous patients. These “NPs” frequently execute the same duties that patients have previously entrusted to their physicians.
Nevertheless, what about nurse practitioners who specialize in patient care? At the very least, that is not yet routine. However, there is a growing trend of nurse practitioners and physician assistants integrating into cardiology, dermatology, and other specialty practices, thereby expanding their expertise and augmenting their income.
This development is concerning to certain individuals who monitor the health workforce, as current trends indicate that primary care, which has employed nurse practitioners to mitigate physician shortages, may soon be unable to rely on them to the same extent.
Atul Grover, executive director of the Research and Action Institute of the Association of American Medical Colleges, stated, “They are succumbing to the same challenges that we face with clinicians.” He asserted that the rates that NPs can command in specialty practices are “considerably higher” than those in primary care.
According to Yalda Jabbarpour, director of the Robert Graham Center for Policy Studies at the American Academy of Family Physicians, the proliferation of nurse practitioner programs in the 1970s appeared promising at first glance, as it produced a large number of nurse practitioners who would collaborate with primary care physicians. Conversely, only thirty percent of individuals are currently enrolling in primary care.
Jabbarpour was alluding to the 2024 primary care scorecard published by the Milbank Memorial Fund, which revealed that the proportion of nurse practitioners employed in primary care practices remained consistent at 32% to 34% from 2016 to 2021, despite their substantial growth. The research revealed that the proportion of physician assistants, or physician associates, in primary care ranged from 27% to 30%.
Nurse practitioners and physician assistants are both advanced practice clinicians who are required to fulfill distinct education, training, and certification requirements, in addition to possessing advanced degrees. NPs are permitted to practice independently of physicians in more than twenty-two states, while PAs have comparable autonomy in a restricted number of states.
According to the American Association of Nurse Practitioners, approximately 88% of nurse practitioners are certified in a primary care area. Nevertheless, it is challenging to determine the exact number of individuals employed in primary care or specialty practices. Medical specialists, in contrast to physicians, are not typically required to obtain accreditation from a national standard-setting organization in order to practice specific disciplines, such as oncology or cardiology. The AANP declined to respond to inquiries regarding its annual workforce survey and the extent to which primary care NPs are transitioning to specialties.
Specialty practices are incorporating these advanced practice clinicians at nearly the same rate as primary care practices, despite the scarcity of data that monitors the change. This is supported by research that was frequently cited in 2018.
The study has revealed a 22% increase in the number of specialized practices that employed nurse practitioners and physician assistants from 2008 to 2016, which is the most compelling evidence of the shift. The number of primary care practices that employed these specialists increased by 24%.
Once more, the Association of American Medical Colleges’ most recent projections indicate that there will be a shortage of at least 20,200 primary care physicians by 2036. Furthermore, there will be a scarcity of non-primary care specialists, with a minimum of 10,100 surgical physicians and a maximum of 25,000 physicians in other specialties not meeting the demand.
Candice Chen, an associate professor of health policy and management at George Washington University, asserts that the duties performed by primary and specialty care are frequently indistinguishable.
“Regardless of your status as a nurse practitioner employed in a cardiology or gastroenterology clinic, your obligations are increasingly merging with those of primary care,” she elaborated.
The salaries of nurse practitioners are subject to significant variations based on the type of facility, location, and experience of the individual. Nevertheless, the total annual average starting compensation for nurse practitioners and physician assistants in specialty practice was $172,544, including the signing bonus, in the year ending March 31, according to data from health care recruiter AMN Healthcare Physician Solutions, formerly known as Merritt Hawkins. This figure is slightly higher than the $166,544 for those in primary care.
In the decade leading up to 2032, the federal Bureau of Labor Statistics predicts that nurse practitioner jobs will increase at a higher rate than those in nearly any other occupation, with a growth of 123,600 jobs or 45%. The occupation of wind turbine service technician is the only one that is expected to expand at the same rate. Additionally, the growth rate for physician assistants is substantially higher than the average, at 27%. In 2022, the number of nurse practitioners surpasses that of physician assistants by more than twofold: 323,900 versus 148,000.
In accordance with Grover of the AAMC, these figures suggest that there will be an adequate number of NPs, PAs, and physicians to meet the primary care needs. He also stated that “a greater number of NPs and PAs should be incorporated into other fields at the same time.”
Twenty-seven years ago, Pamela Ograbisz began her professional career as a registered nurse in a cardiothoracic intensive care unit. Several years after becoming a family nurse practitioner, she obtained employment with a similar specialty practice, which equipped her for a more extensive role. Initially, she was responsible for the outpatient clinic, and she later transitioned to floor work before ultimately assuming responsibility in the intensive care unit.
According to Ograbisz, who is currently the vice president of clinical operations at temporary placement recruiter LocumTenens.com, when nurse practitioners desire to specialize, doctors mentor them in a manner similar to that of a physician residency.
In order to exhibit their proficiency, physician assistants may specialize by acquiring “certificates of enhanced qualifications” in ten distinct specialties or through a mentoring program. Jennifer Orozco, the chief medical officer of the American Academy of Physician Associates, asserts that the majority of employers do not “encourage or require” these credentials.
Family nurse practitioners may enroll in one of numerous training programs to broaden their skill set.
Recently, Raina Hoebelheinrich, a family nurse practitioner at a regional medical center in Yankton, South Dakota, enlisted in a three-semester post-master’s endocrinology training program at Mount Marty University. Currently, she is 40 years old. She shares a homestead with her spouse and five sons in northeastern Nebraska, her neighboring state.
Hoebelheinrich’s newly acquired abilities could be advantageous in both her current hospital position, where she encounters a substantial number of patients with acute diabetes, and a clinic setting similar to the one in Sioux Falls, South Dakota, where she is concluding her clinical endocrinology training.
The lack of access to endocrinology care in rural areas is a substantial concern, as numerous individuals are compelled to travel hundreds of miles to consult with a specialist.