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.