The Growing Nurse Practitioner Workforce in Specialty Care
The Growing Nurse Practitioner Workforce in Specialty Care
The anticipated growth in non–primary care APNs is unprecedented. There are several possible explanations for the growth: the economics of educating a trained workforce; supply and demand; and the success that the NP role has had in primary care. There is significantly greater cost and time involved in training specialty physicians as compared with providing additional training to NPs trained in primary care. Initial training for NPs is obtained by completing a master's degree in nursing or a doctorate in nursing practice after obtaining a bachelor's degree. The graduate education may range from 2 to 3 years of full time study, depending upon the curriculum and degree. After completion of their initial education, NPs may pursue a primary care position or further specialty training during their employment in specialty areas, including medicine and surgical specialties. In contrast, specialty physicians complete their training in a minimum of 9 years (including medical school, residency, and fellowship); a conservative estimate for education costs per physician is more than $585,000. Upon completion of their training, the average compensation for a specialty physician, such as an oncologist, is $341,000 annually. An NP who has been board certified in oncology (advanced oncology certified NP) earns an average annual income of $108,668.
The Association of American Medical Colleges anticipates an insufficient supply of specialty physicians ranging between 28,000 and 63,000 by 2025. Simultaneously, the demand is also anticipated to rise due to several factors: According to the US Census Bureau, the number of Americans ≥ 65 years will more than double between 2010 and 2020, and the number of annual hours worked by physicians is declining, as well as the number of office visits. Older (defined as ≥ 65) Americans utilize health care at increased rates compared with other adults, specifically in rates of physician office visits and hospital outpatient department visits. The combination of larger numbers of older Americans who have increased utilization of health care services and the decrease in the number of hours and office visits available with physicians may contribute to the increased demand for specialty NPs. The greatest deficiency anticipated by the Association of American Medical Colleges in their report is in the surgical specialties. Simultaneously, the largest gain in APN positions anticipated by the National Center for Health Workforce Analysis is in the surgical specialty. It is not clear from the report whether the increase in surgical specialties would be for NPs in a first assistant capacity, as certified registered nurse anesthetists, or in a pre- or postoperative care role.
Before implementation of managed care, the structure of the health care model in the US was with physicians at the center of the model, as the sole decision-makers on patient care. When a deficit of primary care physicians occurred in the mid-1990s, the number of NP professionals increased and successfully filled the primary care provider role. Equivalent outcomes between NPs and primary care physicians have been demonstrated in subsequent research. In the provision of basic primary care services, physicians' additional training has not been shown to result in a measurable difference from that of NPs.
Possible Explanation for Rapid Growth Supply and Demand
The anticipated growth in non–primary care APNs is unprecedented. There are several possible explanations for the growth: the economics of educating a trained workforce; supply and demand; and the success that the NP role has had in primary care. There is significantly greater cost and time involved in training specialty physicians as compared with providing additional training to NPs trained in primary care. Initial training for NPs is obtained by completing a master's degree in nursing or a doctorate in nursing practice after obtaining a bachelor's degree. The graduate education may range from 2 to 3 years of full time study, depending upon the curriculum and degree. After completion of their initial education, NPs may pursue a primary care position or further specialty training during their employment in specialty areas, including medicine and surgical specialties. In contrast, specialty physicians complete their training in a minimum of 9 years (including medical school, residency, and fellowship); a conservative estimate for education costs per physician is more than $585,000. Upon completion of their training, the average compensation for a specialty physician, such as an oncologist, is $341,000 annually. An NP who has been board certified in oncology (advanced oncology certified NP) earns an average annual income of $108,668.
The Association of American Medical Colleges anticipates an insufficient supply of specialty physicians ranging between 28,000 and 63,000 by 2025. Simultaneously, the demand is also anticipated to rise due to several factors: According to the US Census Bureau, the number of Americans ≥ 65 years will more than double between 2010 and 2020, and the number of annual hours worked by physicians is declining, as well as the number of office visits. Older (defined as ≥ 65) Americans utilize health care at increased rates compared with other adults, specifically in rates of physician office visits and hospital outpatient department visits. The combination of larger numbers of older Americans who have increased utilization of health care services and the decrease in the number of hours and office visits available with physicians may contribute to the increased demand for specialty NPs. The greatest deficiency anticipated by the Association of American Medical Colleges in their report is in the surgical specialties. Simultaneously, the largest gain in APN positions anticipated by the National Center for Health Workforce Analysis is in the surgical specialty. It is not clear from the report whether the increase in surgical specialties would be for NPs in a first assistant capacity, as certified registered nurse anesthetists, or in a pre- or postoperative care role.
Before implementation of managed care, the structure of the health care model in the US was with physicians at the center of the model, as the sole decision-makers on patient care. When a deficit of primary care physicians occurred in the mid-1990s, the number of NP professionals increased and successfully filled the primary care provider role. Equivalent outcomes between NPs and primary care physicians have been demonstrated in subsequent research. In the provision of basic primary care services, physicians' additional training has not been shown to result in a measurable difference from that of NPs.