The rise of Accountable Care Organizations and medical homes has spiked demand to unprecedented levels for nurse practitioners, who have become important support players in providing care to those who gained coverage under the Affordable Care Act, according to findings from a Merritt Hawkins survey.
The Irving-based consulting firm found that demand for nurse practitioners and physician assistants increased by 320 percent over the last three years, catapulting them into the top five most desired specialties. Three years ago, neither ranked in the top 20.
“You’re now seeing these mega employers say, ‘you know what? We’re making the decision on our own, and to achieve our ultimate goal of population health, our ultimate goal of an integrated clinical network, you can’t do this with just physicians’,” said Travis Singleton, vice president of Merritt Hawkins. “You’re seeing them employed at 50 or 100 or 200, not just one or two at a time. It’s staggering any way you look at it.”
There are more than 192,000 nurse practitioners registered to practice in the United States, according to numbers from the American Association of Nurse Practitioners. Of those, 88 percent work in primary care. Major providers and insurers are increasingly moving toward team-based models of delivery that track a patient’s medical history, named medical homes and Accountable Care Organizations.
This culture shift spurred an increase in demand for nurse practitioners who assist primary care physicians in keeping patients engaged in their health. At Methodist Health System, for instance, primary care physicians create health plans for patients following checkups and physicals. Nurse practitioners and physician assistants then help ensure the person is following doctor’s orders.
“A lot of practices are looking at extenders, whether that’s nurse practitioners or physician assistants, to help with demand for the populations that they serve,” said Bob Bush, Methodist’s senior regional director for Methodist Med-Health, which manages its family health centers. ”You’re seeing more entities looking at interviewing and adding the mid-level providers to support the physicians.”
Merritt-Hawkins’ findings were culled from surveying 3,158 permanent physician and practitioner search assignments performed by its sister staffing companies between April 1, 2013 and March 31. For practitioners, the firm found that there were 128 searches during that period compared 69 in 2012 and 23 the period before that.
For the eighth straight year, though, family physicians were the most desired of all specialties, a sign that highlights, as the study says, “the continued nationwide demand for primary care physicians.”
The American Medical Association has estimated that the nationwide physician shortage could top 91,500 by 2020. The Dallas area fares better: Despite growing from 6 million to 6.7 million residents between 2007 and 2013, its counties have boosted its physician population along with it.
According to state figures, Dallas County increased physician supply during that time period from 215 to 245 per 100,000 residents. Collin County grew from 170 to 200 per 100,000. The state had an average of 165 physicians per 100,000 residents compared with the national average of 220, according to figures from the Association of American Medical Colleges.
Wait times here are also low: A different Merritt Hawkins survey found North Texas patients wait just 10 days to see a physician, compared with 45 in Boston.
“What we’ve been saying about Dallas for years now is that they’ve been more progressive in utilizing nurse practitioners and physician assistants,” Singleton said. “They’re reaching outside of physicians to meet this access shortage.”
Bush called the healthcare industry a cyclical business. Demand for primary care physicians has increased partly because of the aging baby boomer population, a group that needs more frequent visits to their primary care physician. Also, many physicians a decade ago decided to take another two years of schooling and follow a specialty like cardiology, jobs that often come with higher income than a family care physician.
“They decided, ‘I’m going to do this school thing for two more years and I’m going to be a cardiologist and make a bunch of money,’” Bush said. “Now that’s swinging back the other way because primary care is more in demand. The age of baby boomers is a perfect example; they need more internal medicine and family medicine physicians to guide them through maturation. There’s a big demand for primary care physicians.”
There’s also the flux created by the Affordable Care Act. As incentives switch from fee-for-volume to fee-for-value, longtime physicians are having to learn how to work in interdisciplinary environments, Singleton says. They’ve practiced in silos—now they’re expected to be part of a team. And the incoming physicians are increasingly being trained to work collaboratively.
A big question the industry will have to sort out is how to marry these two disciplines. And currently, Singleton says, the best way to do that is an employment strategy.
“You’re mashing these worlds together at an incredibly rapid speed,” Singleton says. “In a team health environment where you’re controlling or manipulating the behavior of your providers, trying to get all those people in different cultures and different training moving in one direction, employment is the best way to do it.”
Correction: This story incorrectly reported there are 115,000 practicing nurse practitioners in the United States. There are more than 192,000. D Healthcare Daily regrets the error.