Counting the Hard-to-Count: The latest on APNs & PAs

Here at CHI we are working on quantifying the effect of health reform on the need for additional primary care – and what that might mean for the state’s health care workforce. We recently had a question come up about the contribution of nurse practitioners (NPs) and physician assistants (PAs) as providers of health care.

Nearly 5,000 of these providers are registered or licensed in Colorado and nearly two-thirds are NPs.

Tracking the presence and contribution of these providers - while providing job security for health care workforce researchers like myself - is a real challenge for a few reasons. First, while licensing data is the easiest way to count health care providers, not all licensed providers are working full time or even practicing. Second, licensing data, at least in Colorado, does not capture specialties. Finally, NPs and PAs do not commonly bill their services directly and patients may not accurately recall who saw them when responding to surveys.

Luckily for us, the National Center for Health Statistics (NCHS) has just released data from the 2009 National Ambulatory Medical Care Survey on NPs, PAs and certified nurse midwives (CNMs) in physician offices. While the findings don’t report on advanced practice nurses (APNs) working outside of physician offices, it is interesting to see that half of physician offices include at least one of these practitioners.

The presence of at least one APN or PA was most common in primary care and in multi-specialty practices and in practices having at least three physicians. Especially interesting was the fact that physicians in practices with more revenue from Medicaid were 10 percent more likely to work with NPs, CNMs and PAs.

A different analysis of the same survey provides related data for community centers and indicates that NPs provide the care in approximately one in five visits performed in these settings. Health reform and stimulus spending have targeted community health centers as one means of providing care to the newly insured.

Taken together, these findings support the idea that NPs and PAs will have a significant role to play for those newly insured under Medicaid who use their insurance to seek care at community centers. You can check out the findings from CHI’s recent APN and PA surveys on our website.

Athena Dodd is a research analyst at CHI.