Mid-level health professionals in demand in state
Some 39 percent of nurse practitioners and 35 percent of physician assistants in Michigan work in primary care, an area that is expected to rely more heavily on mid-level health professionals as health care reform moves forward.
The Patient Protection and Affordability Act of 2010, patient-centered medical homes, accountable care organizations and the shortage of primary care doctors are factors now putting the spotlight on nurse practitioners and physician assistants, said Michigan Health Council President Anne Rosewarne.
The Michigan Health Council this month released data from a survey it commissioned of registered nurses with certification from the state as nurse practitioners. It follows the release of a survey of physician assistants last fall.
Under state law, nurse practitioners and physician assistants have different scopes of practice, Rosewarne said, and they are trained under different models. Yet more and more, they are playing a similar role in physician offices, hospitals and outpatient settings.
“One of the reasons we put all this out there was so there would be good dialogue about it,” she said. “It’s hard for the lay person to give an opinion on that, but clinical people have good opinions. What I think there needs to be is dialogue with the professionals. We wanted to get the information out there so at least they would have it, look at it and decide.”
Rosewarne said that the survey revealed a migration, for both professions, out of primary care doctor’s offices and into hospitals.
“As hospitals change their hours for residents — they can’t work as many hours — they are back-filling with NPs and PAs,” she said. “They are backing up hospitalists, doing rounds with surgeons, doing a lot of different things that they have not done before. They are wonderful additions to hospitals, but it’s a terrible removal from the primary care doctors’ practices.”
The American Academy of Nurse Practitioners estimated there are 135,000 NPs across the country. In 2009, the American Academy of Physician Assistants estimated PA ranks at 90,000.
The survey found that 49 percent of Michigan’s 4,185 nurse practitioners and nurse midwives have six to 15 years of experience in the role. But 36 percent are age 55 or older, and 39 percent say they expect to leave the job in one to 10 years.
Some 99 percent of nurse practitioners are involved in direct patient care, compared to 83 percent of registered nurses, the report found. Primary care — family practice, internal medicine and pediatrics — provided jobs for about 39 percent of the 986 nurse practitioners who responded.
The state’s nurse practitioners are overwhelming female — 96 percent, and white — 93 percent.
The survey of physician assistants found 2,954 licensed, active PAs in Michigan; 66 percent of them are women. Thirty-five percent work in primary care settings, and 52 percent in doctors’ offices. Eleven percent work in emergency medicine.
The surveys were conducted by Public Sector Consultants for the Michigan Health Council