Advanced medical providers extend physicians’ reach, patients’ access to health
By Deborah Jeanne Sergeant
When you last saw a medical provider, it may not have been a medical doctor.
According to Harvard Medical School, the number of US healthcare visits delivered by physician extenders rose from 14% to 26%. Physician extenders are advanced medical providers, which includes physician assistants and nurse practitioners. They can perform the role of primary care provider.
Why they do so is clear to Marissa Vartak, family nurse practitioner, board- certified in family medicine and owner of On Care Family Health in Cicero.
“PCPs are in a major shortage,” Vartak said. “Nurse practitioners have become the heartbeat of primary care.”
One reason is that more medical residents go into specialties more lucrative than primary care and family practice. Nearly all specialties pay better.
Another, more recent reason is that 20% of all healthcare providers quit practicing during the pandemic. Factors such as the rate of retiring baby boomers has also taken more MDs out of practice. More than half of medical doctors and doctors of osteopathic medicine are older than 55.
Vartak said that the lack of available care providers has driven some patients to use an urgent care or emergency department to receive care.
“It increases costs for insurance companies,” she said. “If insurance companies continue to pay that kind of money, the consumer will have a higher premium and deductible.”
Seeking higher acuity care at the urgent care or ER also takes up providers’ time that should be directed to more acute cases. But Vartak understands patient frustration when a PCP visit can take a long time to book. Her office was booked out six months in advance until she recently hired another nurse practitioner. Now it’s “only” four months.
The care that physician extenders provide is high quality. Vartak said that after becoming a registered nurse, the graduate must earn a master’s degree in nursing and pass exams for a total of six years’ schooling to become a nurse practitioner. In addition, nurse practitioners collaborate with multiple providers as part of the patient’s healthcare team.
Physician Micheal Stephens, associate chief medical officer at Primary Care Physician at Oswego Family Physicians at Oswego Health, said that the cost of student loan debt — around $250,000 — deters many from becoming a primary care provider and instead specialize.
“They may not want to serve in a rural community,” Stephens added.
Many physician extenders serve in these areas and some bounce between two rural towns all week so that more patients can be seen.
According to the American Medical Association, the US is short 37,000 physicians.
“Even though we’ve increased the number of positions available in medical school, the trend is most will bypass primary care and the estimate will be within the decade, we will be over 100,000 physicians short. It won’t help us in the next decade as it takes 12 years and sometimes 18 to 20 years a physician who can practice on their own.”
Compared with the timeline of preparing to become a nurse practitioner or physician assistant, it’s clear that extenders will help bridge the gap.
Stephens also cited physician burnout as another factor in the PCP shortage. Even before COVID-19, the onerous burden of paperwork and dealing with insurance companies was a struggle for providers who only entered practicing medicine because they wanted to care for patients. Taking home two or three hours’ worth of paperwork decreases work life balance. The introduction of the electronic medical record may have made information easier to access, but it also has magnified the administrative work physicians face.
Earning a degree to become a nurse practitioner or physician assistant builds in flexibility into the student’s future career. Stephens said that should they discover they want to specialize, they can do so without a lot of academic backtracking.
Stephens said that advanced practitioners are fully fledged members of the Oswego Health team and he counts them “essential” to the organization’s operation.
“They improve access so patients can see providers and they do a wonderful job,” he said.
