MPH 686 U.S. Health Care Delivery System
February 3rd, 2013
Shortages in primary care providers and general practice physicians have caused an increase in the demand for midlevel providers, physician assistants and nurse practitioners. This paper will discuss the increasing role of these health care professionals, how their roles differ from a physician’s and the impact they will have on the future of the U.S. health care industry.
Keywords: physician, physician assistant, nurse practitioner
Role of Mid-Level Providers in Health Care
The managed care industry continues to develop and change along with technology, policies, procedures and regulations. A physician’s practice behavior has also continued to change and is more sophisticated than ever before. As a result, managed care companies have begun putting less focus on routine care and “more focus on chronic and/or highly expensive medical conditions” (Kongstvedt, 2009). In addition, many medical students are choosing higher-paying specialty fields of study (i.e. ophthalmology or dermatology) over primary fields such as pediatrics, internal medicine and family practice (Rough, 2009). The U.S. population continues to grow and in 2014 implementation of the Affordable Care Act (ACA) will require millions of the U.S. population who were uninsured to become newly insured. It is predicted that there will be a shortage of primary care providers (Health Affairs, 2012). As a result, there is an increased demand for nonphysician and midlevel practitioners, although there is much debate whether midlevel providers such as physician assistants (PA) and nurse practitioners (NP) can replace PCPs effectively. Physicians
It is most common for a physician to have obtained a degree of medical doctor (MD) or doctor of osteopathy (DO). Some states also include other professions, i.e. doctor of chiropractic (DC), as a designated physician. These health care professionals have “a license to prescribe medications, privileges to admit patients to hospitals, and other related attributes” (Kongstvedt, 2009). Physicians can be classified in many ways which include primary care physician (PCP) or specialty care physician (SCP). There are typically four steps that must be completed by individuals who desire to become a physician which include: undergraduate education, medical school, residency and fellowship (American Medical Association, n.d.). It is not uncommon for an individual to spend 15 or more years obtaining their physician’s license and certification. Physician Assistants
Most PAs have a master’s degree and follow a medical type program of study (Kess, 2011). Their training programs focus on medical aspects of health care which provides them with the skills of a general practitioner, however, many PAs specialize in primary care, pediatrics and general surgical care (Kess, 2011). According to the Physician Assistant Education Association and the AAPA (as cited in Kess, 2011), PAs spend nine to 15 months in supervised clinical training after completing a four-year degree and two years of physician training assistant programs. To legally work as a PA, one must pass the Physician Assistant National Certifying Examination and many also choose to specialize in pediatric medicine, emergency medicine and occupational medicine (Lewis, n.d.). Nurse Practitioners
Most NPs also hold either a master’s or doctorate degree (Kess, 2011). In order for a NP to qualify for a graduate program, one must first obtain a nursing degree and have professional nursing experience prior to entering the program (Kess, 2011). To legally work as a NP, one must pass the National Council Licensure Examination for Registered Nurses and many also choose to specialize in geriatrics, family practice and...