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How Teamwork Can Save Primary Care

Alexandra Wilson Pecci, for HealthLeaders Media, August 27, 2013

A shift away from fee-for-service and toward a population management model of healthcare wouldn't involve nurse practitioners and physician assistants replacing doctors; it would call on all providers to work together as a team.

Just like physicians, nurse practitioners and physician assistants are increasingly choosing to specialize, rather than to practice primary care, says a research "one-pager" from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

On the surface, this little nugget of information might seem a bit unremarkable. After all, primary care salaries generally fall short of those in specialty fields, and practitioners face heavy financial burdens, such as education debts.

But there are more wide-ranging implications of this PA/NP subspecialty trend, and they are neatly summarized by the one-pager's title: "Relying on NPs and PAs Does Not Avoid the Need for Policy Solutions for Primary Care."

Other data has suggested that a majority of NPs graduate with primary care degrees, but those numbers don't accurately reflect where NPs actually practice a few years after graduation. (Check out another instance of measuring specialties too soon after graduation here).

Using data from the National Provider Identifier, (and assuming that NPs and PAs who practiced without a physician or co-located with a primary care physician were providing primary care), the Graham Center researchers concluded that fewer than half of PAs and slightly more than half of NPs practice in primary care.

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2 comments on "How Teamwork Can Save Primary Care"


Dave Mttman, PA, DFAAPA (8/28/2013 at 10:12 AM)
That it's not that easy is right. Nps and PAs are kept away from primary care by barriers that make it harder to practice than many other specialties. Put a call into the Association of Family Practice PAs and the AANP please. Get both sides of the picture. You only quote the AAFP who let me say as a PA has been rabidly against PAs and NPs doing anything more than what we are doing now. When teams really function as teams we will be on them. The AAFP does not want a team-just it running the show. Please have your commentary reflect that fact also. Dave Mittman, PA, DFAAPA

Peter McMenamin, PhD (8/27/2013 at 3:24 PM)
There are other ways of estimating primary care performance of NPs. CMS recently awarded nearly $50 million to 35,080 NPs billing Medicare Part B carriers under their own NPIs for exceptional provision of primary care services. That was more than two thirds of the NPs enrolled as Part B providers. This is explained in more detail in http://www.ananursespace.org/BlogsMain/BlogViewer/?BlogKey=ee0e605b-0499-4b47-bfe4-941fb9e13715. CMS data also reveal that of all NPs participating in Part B, only 15% indicated a non-primary care NP taxonomy when first registered for their NPI. Were Medicare to operate with a national scope of practice for APRNs like the VA or DOD, Medicare beneficiaries would have even greater access to primary care services. This is needed because between 2 to 3 million persons will age into Medicare every year for the rest of the century.