Who’s On First: A Look at Workforce Projections

This inverse relationship—more potential patients and fewer people to care for them—suggests perilous changes for our health care system. Some anticipated changes—longer wait times for care, increased costs, and more opportunities for error—are real and have already been quantified in reports.⁹ But with the year 2025 less than a decade away, where is our sense of urgency? Even if we implement changes immediately, they are unlikely to offset the consequences of the workforce shortage. Yet to do nothing will lead to a rapid decline in quality of life for many Americans.

In theory, there are two ways to address this pending “crisis.” We can decrease demand and/or increase supply. In the next few decades, achieving the former will be difficult, because of the unavoidable toll of an aging population. Public health and preventive services may have some impact and deserve increased attention. New and improved modes of treatment offer the potential to ameliorate the impact of chronic diseases such as diabetes and cardiovascular disease. This method, while a noble goal, is also less predictable and harder to “plan” for.

The most direct approach (but certainly not the only one) is to increase the supply of health care providers—specifically, NPs and PAs—in order to meet the rising demand. The professions have long been touted as a solution to problems of access to care in both rural and urban areas. About 83% of NPs are certified in primary care; we cannot ignore the fact that only 24% of PAs practice in primary care while the rest have chosen specialties. But (another plus) patients tend to be as satisfied with care provided by NPs and PAs as by physicians.^10,11

Increasing the supply of NPs and PAs requires educating more individuals to enter the professions. Education programs need to do a critical analysis of their curricula to ensure that what happens in the classroom matches real-world needs. If graduates enter the workforce unprepared for the demands of the job, no progress will be made. (For a vigorous discussion on the current state of professional education, please visit www.mdedge.com/clinicianreviews/commentary).

One significant limitation to the growth of the PA supply is the accreditation process, which now takes almost three years from the start of the process until the initial approval of a class (and five years until the first class graduates). This process adds time and expense to the creation of new education programs, many of which await approval and lack the resources to bring the program to maturity. While no one would argue the value of the ARC-PA accreditation, the process should be critically examined to identify any areas that can be streamlined without decreasing the quality of the product.