Nurse practitioners have made significant gains — in number and stature — during the past decade. Tectonic shifts in the healthcare landscape helped buoy a surge in NP education and employment. The landmark findings of the Institute of Medicine in support of NP practice, the requirements of the Affordable Care Act, the increasing complexity of healthcare delivery, and a shortage of physicians, particularly in rural areas, have all contributed to the rapid growth of the NP workforce. According to a 2018 survey by the American Association of Nurse Practitioners (AANP), 270,000 NPs currently practice throughout the U.S. — more than double the number of practicing NPs in 2007.

Healthcare organizations acknowledge both the quality care and cost savings NPs offer; but, importantly, patients have caught on, too. Not long ago, seeing an NP instead of a physician was more exception than rule. The NP moniker is fast becoming a household term as patients increasingly place their faith in the capabilities of these non-physician clinicians. A newly published evaluation by the Health Care Cost Institute shows primary care visits to NPs (and physician assistants) rose by more than 129% between 2012 and 2016. AANP says more than a billion patient visits were made to NPs in 2018 alone.

That’s good news for a profession that has struggled to gain recognition for its expertise, as is a steady upward trend predicted for NP hiring. But rising acceptance of their role doesn’t mean NPs have reached the apex of their profession. There are still hills to climb.

Here’s a look at opportunities and challenges for NPs in the coming decade:

1.     Primary care progression. The research is clear: Patients who have access to primary care services lead healthier lives and live longer. Also clear: The demand for primary care services will rapidly outpace the supply of physician providers. The U.S. Department of Health and Human Services predicts a shortfall of more than 23,000 primary care physicians by 2025; other workforce analysis shows a physician deficit in primary care could reach 50,000 by 2030. The majority of NPs (72%), on the other hand, already deliver primary care, according to AANP’s survey; and the overall number of NPs is predicted to grow by 47% by 2025. Expect to see rising emphasis on NP hiring in primary care, not only in rural communities that face the harshest scarcity of providers, but in urban and suburban outpatient clinics, retail spaces, and community settings as well.

2.     At the center of the care continuum. NP hiring won’t be confined to outpatient settings; acute care facilities seek NPs to manage the patient care cycle from inpatient stay and discharge through outpatient follow-up. Look for more NPs serving as facilitators in acute care environments, where they foster communication between healthcare disciplines, reducing both cost and the potential for medical error.

3.     Autonomy on the agenda. NPs have prescriptive privileges, including for controlled substances, in all 50 states and the District of Columbia. Only 22 states and DC permit NPs to work independently of physicians, however; most of those states cover rural areas facing shortages of physicians. In heavily populated states such as California, NPs’ scope of practice is labeled restrictive, meaning NPs need physician oversight to diagnose and treat patients, as well as prescribe medication. The federal government established a position in the long-running debate over NPs’ autonomy when the Department of Veterans Affairs granted full practice authority to NPs in 2016, a move still considered controversial in some states and among some groups, such as the medical community. Watch as deliberations over widening NPs’ scope of practice continue to roll through state legislatures as they grapple with primary care physician shortages, healthcare access, and cost containment.

4.     Commensurate cash. Equal pay for equal work is another perennial argument put forth by NPs. AANP and other NP associations continue to lobby for equitable reimbursement from third-party payers. Currently, NPs are reimbursed by Medicare at 85% of the physician rate; but commercial insurers, managed care organizations, and healthcare facilities typically also pay NPs less than physicians even though, particularly in primary care, they provide the same services and incur the same overhead costs. In a step up on the money scale, a Medscape survey showed a greater uptick in compensation for NPs than other advanced practice RNs in 2017. NPs working full-time in that year earned an average salary of $112,000, a 6% increase in wages over the previous year.

5.     Where do we go from here? Healthcare has moved to the top of the agenda among consumers and, consequently, legislative bodies at both the state and federal level. Watch for more dissecting of the U.S. healthcare system and proposals to alleviate its ills during the 2020 election cycle and beyond. Will universal, or single-payer, healthcare proceed in states like California, and will it serve as a pilot for other states? Will the Affordable Care Act be bolstered with federal dollars or disbanded? The answers could have profound effects on either the expansion or restriction of NP practice. Primary care NPs also should be on alert for innovative theoretical models generated from within the healthcare sector, such as NP-physician co-management, an arrangement in which the two professionals share workload responsibilities and jointly manage the care of the same patient. While uncertainties surround the future of healthcare delivery, NPs at Eisenhower Health can be assured of our steadfast commitment to their practice. Our passion for the health and well-being of our community is unmatched in the Coachella Valley, as is our dedication to the NPs who help us deliver the highest quality primary care to the patients we serve. As the only Magnet-designated facility in the Palm Springs area, Eisenhower Health has demonstrated its commitment to nursing excellence, evidence-based practice and research, nursing professional development, and high levels of patient satisfaction in both our acute care facility and more than 30 state-of-the-art clinics located throughout our community. NPs who join our team of professionals will find a collaborative, respectful practice environment that promotes relationship-building and recognizes their vital contributions to exemplary patient care. Share your expertise with a noted healthcare leader that offers competitive compensation and benefits. Learn more about rewarding opportunities for NPs on our Careers page.


Originally posted on 17/4/2019

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