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How Teamwork Can Save Primary Care

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

These findings are in line with other similar numbers, such ones from the 2008 American Academy of Physician Assistants' PA census report, which showed that only 37% of PAs work in a primary care specialty.

PAs and NPs have been increasingly thought of as a kind of balm for alleviating the primary care shortage. But with so many of them practicing outside of primary care, this kind of thinking clearly ignores a larger issue: There aren't enough incentives for anyone—physicians or APRNs—to enter primary care. And moreover, the way primary care is paid for needs to change.

The takeaway for policy makers?

"This is not an easy fix," study co-author Robert Phillips, MD MSPH, VP for research and policy at the American Board of Family Medicine, tells me. "They can't dodge the hard work of making primary care more attractive to all three professions."

Although expanding the scope of practice for NPs and PAs has gotten a lot of attention, Andrew Bazemore, director of the Graham Center and another co-author, argues that what's really needed is a shift away from fee-for-service models and toward population management. Such a shift wouldn't involve NPs and PAs replacing physicians; it would call on all providers to work together as a team.

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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.