Role of PAs and NPs in Addressing Workforce Shortage
After adjusting for varying levels of utilization related to insurance plan type, the 725,000 new (2014) rural enrollees in the five levels of insurance plans available on federal and state exchanges- platinum, gold, silver, bronze and catastrophic- are expected to generate 1.39 million rural primary care office visits.
At a national level it would require 345 full-time equivalent physicians to provide those visits to new rural enrollees. If only 70 percent of those visits were provided by physicians, 56 additional full-time physician assistants (PA) and 68 additional full-time nurse practitioners (NP) would be required to provide the remainder. If physicians provided half of the new enrollee visits, 93 additional PAs and 113 additional NPs would be required to provide the remainder.
There is substantial regional variation in the need for rural providers to meet the needs of rural enrollees. Particularly high levels of need were found in the East North Central, West North Central and South Atlantic census divisions.
Using PAs and NPs to help meet the needs of newly insured populations in rural areas may be an effective strategy to alleviate the effects of physician shortage, especially in states with less restrictive practice environments for non-physician primary care providers.