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NPs, PAs Choosing Subspecialty over Primary Care, AAFP Says

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Primary-care physicians have routinely fought the notion that nurse practitioners and physician assistants are the solution to the physician-shortage crisis, and now the American Academy of Family Physicians (AAFP) is saying NPs and PAs may not even be able to fill the shortage, reports David Pittman of MedPage Today.

The main reason for this is similar to the reason why the physician shortage itself exists to begin with: NPs and PAs typically choose to work for subspecialty practices as opposed to primary-care practices.

According to the AAFP study, “Many nurse practitioners graduate with family, adult, or pediatric degrees, but then go on to work in subspecialty offices, similar to the preponderance of physicians entering residency in internal medicine or pediatrics at the end of medical school who go on to further training and practice in subspecialties.”

Expanding on this, the report also speculates NPs and PAs are choosing subspecialty careers over primary-care careers because of “student debt and income-gap disparities,” adding this point of clarification: “Although NPs and PAs may also benefit from factors that increase the likelihood of choosing primary-care careers, such as training experiences in rural and underserved communities, debt reduction, and selection of students intent on caring for underserved populations, further studies are needed to know for sure.”

Regardless, “fewer than half of PAs and slightly more than half of NPs were practicing in primary care.”

Robert Graham Center director Andrew Bazemore, MD, MPH, said, “We are finding that the trends towards subspecialization we see among physicians are also occurring in the nurse-practitioner and physician-assistant communities. This finding corroborates recent federal studies of nurse practitioners and those of physician assistant organizations.”

Still, the AAFP’s findings aren’t halting legislation to give NPs and PAs expanded authority, noted Pittman, with lawmakers “pressing ahead and including nonphysician providers in a bill that reforms Medicare's provider payment system,” the bill being H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013.

An amendment to the bill looks to “reward all medical providers running a patient-centered medical home for chronic-care management,” as opposed to only rewarding physicians, which is how the program is structured now.

The report concludes, “Relying on NPs and PAs to solve the problem of a growing shortage of primary-care physicians may not be an option, and policymakers should not abandon policy solutions designed to increase the number of primary-care physicians, NPs, and PAs.”

It begs to be noted where the AAFP’s interests lie in conducting this study: the organization is among those who are “adamant that NPs must work in a medical team with physicians at the helm.”

As nurse practitioners and physician assistants who are looking for jobs, what kind of practices are you looking for, primary care or subspecialty? Why?

And physicians, what is your experience in hiring NPs and PAs? Is recruiting them for primary care becoming more difficult?

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