Doctor shortage may not be as bad as feared, study says

Kelly Kennedy | USA TODAY

WASHINGTON — New roles for nurse practitioners and physician assistants may cut a predicted shortage of physicians by about 50%, according to a new study released Monday.

The surge in new patients covered by health insurance that will be sparked by the Affordable Care Act has led to predictions that there will be a shortage of 45,000 primary care physicians by 2025, about 20% less than the predicted demand, said David Auerbach, a policy researcher at the Rand Corp., a non-profit policy think tank that conducted the study published Monday in the journal Health Affairs.

Those studies, Auerbach said, were based on the assumption that health care practices would not change how they operate and ignore provisions in the 2010 law that allow the creation of nurse-managed health centers and medical homes that could relieve physicians of some of their caseload. Technology improvements, also spurred by the law, could also relieve part of the shortage, he said.

"The story has been, 'There's a looming physician shortage, and the Affordable Care Act's going to make it worse, so what are we going to do?" Auerbach said. "But even policy-makers looking at those numbers don't realize they're coming from a static, unchanging way of how we deliver care."

A surplus of 34,000 nurse practitioners, about 48% above demand, and 4,000 surplus physician assistants will help relieve the doctor shortage, Auerbach and his research team found.

Two elements are critical to relieving the shortage, Auerbach said:

• Medical homes. A group of people working together to provide care. A physician, physician assistant or nurse practitioner leads the team of doctors, nurses, pharmacists, nutritionists and social workers using electronic health records and care coordination. Each team can care for larger numbers of patients than a doctor could on his or her own.

• Nurse-managed health centers. These are centers managed by nurses consisting of nurse practitioners. Usually, they are affiliated with academic medical centers, and they often provide specialty care to low-income populations.

"I think these changes can matter quite a lot," Auerbach said. "It's sort of a given: If you use nurse-managed health centers, you're not using a lot of doctors. But patient-centered medical homes, I guess we really didn't know the outcome."

So far, Auerbach said, researchers have seen positive examples of how the changes can work, but they need more analysis.

The new health law promotes these models because they save money, and has provided up to $50 million in direct grants to support nurse-managed health centers. And there are pilot programs for Medicare and Medicaid patient-centered medical homes. The authors said states may need to "liberalize" scope-of-practice laws for nurse practitioners and physician assistants to fill those roles, as well as supply more nurses and aides.

The American Association of Nurse Practitioners is launching a new advertising campaign to try to push for those opportunities, as well as to help people understand what nurse practitioners do.

According to the American Academy of Physician Assistants, 60 new physician assistant programs were waiting for accreditation as of May, and they expect 10,000 new physician assistants by 2020.