Nurse practitioners, physician assistants accounted for 25.6% of patient visits in 2019

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Patient visits with nurse practitioners (NPs) and physician assistants (PAs) grew from 14% of visits in 2013 to 25.6% in 2019, according to a new study.

Physicians may be guiding medical care but increasingly NPs and PAs are the ones meeting with patients, according to new research in “Provision of evaluation and management visits by nurse practitioners and physician assistants in the USA from 2013 to 2019: cross-sectional time series study.” The report was published in The BMJ.

The researchers analyzed a sample of billing and prescription data from Medicare. They found in 2019, of more than 16.24 million patients with at least one medical visit, more than 6.8 million, or 42%, had at least one NP or PA visit, and more than 1.68 million, or about 10%, had visits only with an NP or PA.

“These results illustrate the rapidly growing involvement of nurse practitioners and physician assistants in the U.S. health care system,” the study said. “The proportion of care provided by nurse practitioners and physician assistants will likely only increase over time because substantially more new nurse practitioners and physician assistants are entering the workforce compared with physicians.”

The study differentiated among medical specialties. In primary care, physician visits per patient per year decreased by 18%. Primary care physicians were more likely to provide new patient visits but less likely to provide annual exams, compared to NPs and PAs.

Respiratory infections (41.5%) and anxiety disorders (36.7%) had the highest proportions of NP and PA visits. The smallest proportions involved heart disease (18.2%) and eye disorders (13.2%).

For patient characteristics, patients with lower incomes, living in rural areas, or are disabled, had the greatest likelihood of receiving care from NPs and PAs. Nursing facility residents also increasingly deliver care from NPs and PAs.

“Taken together, these results suggest that nurse practitioners and physician assistants provide more care to underserved communities in the U.S.,” the study said.

In coming years, the trends may continue, with 80% growth, or 159,000 positions, predicted for NPs and 48% growth, or 58,000 positions, forecasted for PAs from 2019 to 2031, according to U.S. Bureau of Labor Statistics cited in the study. Meanwhile, the Association of American Medical Colleges has projected a physician shortage up to 124,000 by 2034, with primary care doctor shortages estimated from 17,800 to 48,000.

The findings could have implications for global health care. The United States has fewer physicians per capita than other industrialized countries, but NPs and PAs are filling in health care gaps. Other countries may examine the situation in addressing their own clinician shortages, the study said.

The researchers noted they did not include 2020 data to avoid skewing any numbers due to the COVID-19 pandemic. There are limitations because the results from Medicare data may not apply to other patient populations using commercial insurance, Medicare Advantage, or Medicaid. The figures also did not account for care delivered by many other practitioners, such as social workers or psychologists.

“Despite these limitations, we believe our results provide the best available estimate of the involvement of nurse practitioners and physician assistants in the U.S. health care system,” the report said.