At a glance
- By JAKE MILLER
- From 2013 to 2019 the share of U.S. health care visits delivered by non-physicians such as nurse practitioners or physician assistants increased from 14 to 26 percent.
- This rapid shift requires caregivers, medical educators, and policymakers to understand and manage this growing segment of the health care workforce.
The proportion of health care visits delivered by nurse practitioners and physician assistants in the US is increasing rapidly and now accounts for a quarter of all healthcare visits, according to a study published Sept. 14 in the BMJ.
The analysis, led by researchers from the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School, highlights the rising importance of this rapidly growing segment of the U.S. health care system.
The research is the first nationally representative study of the share of health care delivered by nurse practitioners and physician assistants, collectively known as advanced practice providers. It is also the first study to look at care delivered across different clinical conditions. The researchers analyzed 276 million visits from a nationally representative sample of Medicare insured patients.
Study co-authors Ateev Mehrotra, professor of health care policy at HMS, and Sadiq Patel, a former NIH postdoctoral fellow at HMS, spoke with HMNews about the increasingly important role these providers play in our health care system.
Harvard Medicine News: How did we get to the point where a quarter of all medical visits are conducted by nurse practitioners and physician assistants, not by physicians?
Mehrotra: The roles of nurse practitioners and physician assistants were created in the mid 1960s to address what were already identified at that time as physician shortages. We looked specifically at the years from 2013 to 2019, when the proportion of all traditional health care visits delivered by nurse practitioners and physician assistants increased from 14 to 25.6 percent.
That's the average, but it varied across different conditions. Forty-seven percent of respiratory infection visits and 31 percent of visits for anxiety disorders were conducted by nurse practitioners and physician assistants, but it was only 13 percent for eye disorders and 20 percent for hypertension.
HMNews: What's driving this recent growth?
Mehrotra: The short answer is supply and demand. The U.S. has fewer physicians per capita than most of our peer nations. Who is going to provide that care? The number of nurse practitioners and physician assistants has grown more quickly than the number of physicians. And this trend will only continue as we move forward.
The U.S. Bureau of Labor Statistics estimates that between 2019 and 2031 the number of nurse practitioners in the U.S. will increase by 80 percent and the number of physician assistants by nearly 50 percent. In contrast, the growth rate for physicians over the next decade or so is estimated at less than 5 percent.
HMNews: Are there some patients who are more likely to see nurse practitioners or physician assistants than others?
