Commentary

Are We Overproducing NPs and PAs?

Clinician Reviews. 2018 December;28(12):6-7

References

1. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2016 to 2030—2018 Update. Final Report. March 2018. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf
2. Institute of Medicine. Graduate Medical Education That Meets the Nation’s Health Needs. Washington, DC: The National Academies Press; 2014.
3. Cooper RA. New directions for nurse practitioners and physician assistants in the era of physician shortages. Acad Med. 2007;82(9):827-828.
4. American Academy of PAs. What is a PA? Frequently asked questions. www.aapa.org/wp-content/uploads/2018/06/Frequently_Asked_Questions_4.3_FINAL.pdf. Accessed November 14, 2018.
5. American Association of Nurse Practitioners. NP Fact Sheet. www.aanp.org/about/all-about-nps/np-fact-sheet. Accessed November 14, 2018.
6. Accreditation Review Commission on Education for the Physician Assistant. Accredited programs. www.arc-pa.org/accreditation/accredited-programs/. Accessed November 14, 2018.
7. Salsberg E. The nurse practitioner, physician assistant, and pharmacist pipelines: continued growth. Health Affairs. May 26, 2015. www.healthaffairs.org/do/10.1377/hblog20150526.047896/full/. Accessed November 14, 2018.
8. American Association of Nurse Practitioners. Planning your NP education. www.aanp.org/student-resources/planning-your-np-education. Accessed November 14, 2018.
9. United States Department of Labor, Bureau of Labor Statistics. Occupational outlook handbook: healthcare. www.bls.gov/ooh/healthcare/home.htm. Accessed November 14, 2018.
10. Dalen JE. The moratorium on US medical school enrollment, from 1980 to 2005: what were we thinking? Am J Med. 2008;121(2):e1-e2.
11. Dehn RW, Cawley JF. Looking into tomorrow: health workforce issues confronting physician assistants. JAAPA. 2000;13(11):29-32, 35-38, 43-46.
12. Tavernise S. Doctoring, without the doctor. New York Times. May 25, 2015. www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html. Accessed November 14, 2018.

As I listen to those rumblings of “too many NPs and PAs,” I wonder if this is a mirror to that GMENAC response. Have the NP and PA professions worked so hard to offset the physician shortage (real or imagined) that we may face a glut of NPs and PAs? If so, the concern is that within five to 10 years, we won’t have employment opportunities for all of them. That’s the fear driving these whispers, isn’t it?

As far back as 2000—when this conversation was in its infancy—Dehn and Cawley discussed the consequences of expanding the supply of NPs and PAs. They questioned how the number of, and demand for, NPs and PAs would be balanced in America’s future health care marketplace and wondered if a sharp growth in NP and PA graduates (in conjunction with similar increases in other health professions) could surpass demand and prompt an oversupply, resulting in underemployment and market saturation.¹¹

So, is it time to pause and take another look at the numbers and needs? Maybe. But I believe one of the aspects we must continue to focus on is the quality of our professions. In the wake of the projected physician shortage, the NP profession developed its Doctor of Nursing Practice and the PA profession added postgraduate training opportunities in specific specialties. These not only enhance NPs’ and PAs’ professional credentials—they equip us to provide better patient care. At the end of the day, our ability to care for patients will be the rubric upon which we are judged.

We’ve already been making the case for our professions and gaining recognition throughout this process. When Salsberg wrote about the physician shortage in Health Affairs (2015), he reminded us that a critical factor is the supply and availability of clinicians other than physicians (NPs, PAs, midwives) who can make a significant contribution to access and efficiency of health care. He called for NPs and PAs to be fully integrated into the delivery system and to be allowed scope of practice consistent with their education and training.⁷

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Are We Overproducing NPs and PAs?

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