The evolution of primary care and the growing role of advanced practice clinicians

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In the United States, we are facing an increasingly severe shortage of primary care physicians: More than 100 million Americans do not have access to primary care due to a lack of providers in their local community. Even before the COVID-19 pandemic, the Association of American Medical Colleges was already predicting a primary care shortage of as many as 48,000 doctors by 2034. As increased burnout rates push many physicians into early retirement from primary care, the true scale of the future shortage may be expanding.

The American Association of Nurse Practitioners (AANP) reports that nearly 90% of nurse practitioners (NPs) have been trained in primary care, and the American Academy of Physician Assistants (AAPA) reports that almost a quarter of physician assistants (PAs) specialize in primary care. The U.S. Bureau of Labor Statistics estimates that NPs are the fastest-growing profession in the nation, and PAs are not far behind. Through 2030, the CAGR for NPs is forecasted to be 6.8%, with 4.3% for PAs.

Laura Kline, MBA, CPCU
_{The Doctors Company}

NPs and PAs, alongside nurse anesthetists and midwives, are pivotal to addressing the primary care gap, now and in the near future. Our primary care landscape is not only facing a physician shortage, but also a massive shift in our systems for health care delivery. Corporate giants continue to extend their reach into primary care. For instance, Amazon recently completed its acquisition of One Medical for $3.9 billion. These new options in the health care space are shifting patients’ expectations. In response, many traditional primary care practices and health care systems are modifying their care delivery models.

Meanwhile, many patients find themselves exhausted from and exasperated by the many barriers to swift access to care – and yet craving an ongoing relationship with a trusted medical professional. APCs may be the United States health care system’s linchpin to restoring that all-important continuity of care.

Role definition and authorization protocols enable top-of-license practice

Many medical practices, health care systems, and hospitals – not to mention retail clinics – are recognizing the value of incorporating APCs into their teams. With thoughtful consideration of role definition and authorization protocols, traditional practices that add APCs to their clinician roster can give patients swifter access to care, while allowing physicians to focus on complex cases. In this way, patients benefit from greater access to care, while clinicians enjoy the professional satisfactions and business efficiencies of practicing at the tops of their licenses.

Integration of advanced practice clinicians improves continuity of care, care access

The specifics of scope of practice and supervisory requirements for APCs vary from state to state, but APCs know when to consult a physician, just as primary care physicians consult and collaborate with specialists when necessary. Collaboration among physicians and APCs can prepare the ground for longitudinal practice, with all the benefits that continuity of care delivers to both patients and practitioners.

Moreover, the benefits stretch far beyond individual patients and clinicians. Patient access to primary care is indispensable for halting the escalation of medical conditions before they reach an urgent or emergent level. This helps preserve access to the emergency department, which benefits our entire health care system and society at large

Scope of practice will continue to evolve

The regulatory environment is also a factor in the increasing prevalence of APCs, as the vast majority of states explicitly identify NPs as primary care providers. The same cannot be said for PAs and other APCs, but given the trend toward increasing physician shortages, and with NPs as a precedent, more APCs could be licensed for independent practice in the next decade.

All these trends have combined into a new landscape for primary care. This new landscape underlies everything from patient-facing interactions to practices’ business structures to clinicians’ liability – APCs who opt for independent practice face a parallel elevation of their liability exposure, and they need superior malpractice coverage, risk management resources, educational support, and practice management solutions to deliver the best possible care to their patients. It is our collective responsibility to evolve and innovate to advance the practice of good medicine.

Laura Kline, MBA, CPCU, is the senior vice president of business development for The Doctors Company and TDC Group. She is a leading expert in the areas of health care and medical malpractice insurance. TDC Group offers professional liability insurance tailored for advanced practice clinicians.