NPs bridging the gap in Primary Care
As the number of people over the age of 65 continues to grow with the aging of baby boomers and increased longevity, the need for accessible, coordinated and collaborative primary care for this population also grows. The older population (65+) numbered 40 million in 2010, and the number of Americans aged 45-64 who will reach 65 over the next two decades increased by 31% over the past ten years. Over one in every eight, or 13.1%, of the population is an older American, and persons reaching age 65 have an average life expectancy of an additional 18.8 years (20.0 years for females and 17.3 years for males). Older people have a higher prevalence of chronic disease that needs to be managed, are more prone to experience falls and related injuries, and more rapidly lose function resulting in the need for long term care. Most older persons have at least one chronic condition and many have multiple conditions. 1
The complexity of caring for this diverse older population means that we need a healthcare workforce prepared to address these challenging healthcare needs. The primary care setting is the hub for not only the management of chronic disease, but also the prevention of avoidable function loss and the coordination of care as people move in and out of different healthcare settings as their healthcare needs change. There is a need for primary care providers to have the access to resources that enhance their ability to deliver this kind of care. Effective primary care depends on high functioning, interprofessional teams which utilize evidence-based practice to achieve quality outcomes. There is, however, a crisis in primary care. By 2020 there will be a shortage of as many as 45,000 primary care physicians.
The 2008 Institute of Medicine (IOM) report, Retooling for an Aging America: Building the Healthcare Workforce 2, underscores that our current healthcare system is ill-equipped to deal with this pending crisis. The report lays out
the demographics, health status, and long-term needs of this population, and the challenges in caring for the aging population. It recommends that all healthcare professionals be trained to care for older adults and that there needs to be increased recruitment and retention of geriatric specialists in all fields of practice.
Geriatricians can address the healthcare concerns of older adults, but there simply are not enough physicians prepared as geriatricians to meet this need. Recent workforce projections estimate that 150,000 physicians will be needed in the next 10-15 years to meet the goal of providing primary care access to all U.S. citizens.3 This workforce projection will be particularly acute for primary care physicians since only 2% of all new physicians chose primary care for their career path in 2008.4 NPs provide high quality and cost effective care, produce outcomes comparable to physicians, and provide care that covers 80-90 percent of the services physicians provide.5,6
In 2010 President Obama addressed the House of Delegates at the American Nurses Association to announce a number of investments to expand the primary care workforce. It included increasing funding for nurse/NP-run clinics to “work well for nurses and doctors, and to improve the quality of care for patients”.7 Nurses have been providing care to vulnerable and medically underserved populations through Nurse Managed Health Clinics since the 1960’s. Many of these sites are Federally Qualified Health Centers (FQHCs), which have traditionally served families with children, and they have recently been certified as medical homes.
It is time for sweeping regulation to allow NPs to practice independently and provide these essential services to the growing number of people needing primary care. In order to maintain older adults at their highest level of function, manage chronic disease and keep them safe in the community, there needs to be adequate access to quality primary care. Nurse Practitioners can provide this care and must be allowed to be full partners practicing independently in team based primary care.
1. Administration on Aging. A Profile of Older Americans: 2011. U.S. Department of Health and Human Services. 2011. (Online accessed March 18, 2012)
2. Institute of Medicine. Retooling for an Aging America, Rebuilding the Healthcare Workforce. Washington, DC: National Academy Press. 2008.
3. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections Through 2025. 2008.
4. Hauer, K. et al. Factors Associated With Medical Students’ Career Choices Regarding Internal Medicine. Journal of the American Medical Association. 2008. 300(10):1154-1164
5. Mezey,M. et al. Experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes. Journal of the American Geriatrics Society. 2005. 53(10):1790-1797.
6. Lenz,E. et al. Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care research and review. 2004. 61(3):332-351.
7. White House. Remarks by the President to the American Nurses Association. 2010. http:/whitehouse.gov/the -press-office/remarks-president-a-joint-session-congress-health-care.