A Tale of Two Professions Physician Assistants and Nurse Practitioners Albert Simon DHSc, MEd., PA Associate Professor and Vice Dean School of Osteopathic Medicine in Arizona 1
Objectives Identify key characteristics of the PA and NP professions which define origin, philosophy and current state of practice. Outline the contribution of each profession to the American Healthcare system. Compare and contrast the educational requirements for each profession. Analyze current professional trends to predict future directions 2
Outline Definitions Healthcare Workforce and Origins of the Professions Overview of the Physician Assistant profession Physician Assistant education Overview of the Nurse Practitioner profession Nurse Practitioner education Current Issues Question and Answer 3
Definitions Getting on the same page PC notes to know 4
Its all in the Name Non-physician clinicians (also called Nonphysician providers, physician extenders, midlevel providers) Physician Assistants Advanced Practice Nurses Nurse Practitioners Nurse Anesthetists Nurse Midwifes Clinical Nurse Specialists 5
Nurse Practitioner NPs are advanced practice nurses who provide high-quality healthcare services similar to those of a physician. NPs diagnose and treat a wide range of health problems. They have a unique approach and stress both care and cure. Besides clinical care, NPs focus on health promotion, disease prevention, health education and counseling. American Association of Nurse Practitioners, n.d. 6
Physician Assistants A physician assistant (PA) is a medical professional who works as part of a team with a doctor. A PA is a graduate of an accredited PA educational program who is nationally certified and state-licensed to practice medicine with the supervision of a physician. Also referred to as Physician s Assistant, Physician Associate, Medex American Academy of Physician Assistants, n.d. 7
Healthcare Workforce and Origins of the Professions 8
Clinicians in the United States* Males Females Total % of total Physicians (MD s) 665,647 256,257 921,904 77% Physicians (DOs) 41,280 21,840 63,120 4% Nurse Practitioners (NPs) 5,600 134,400 140,000 12% Physician Assistants (PAs) 32,617 47,089 79,706 7% *2009 data Danielsen, Balweg, Vorvick, and Sefcik, 2011 9
Healthcare Workforce US Department of Health and Human Services estimates physician supply will increase by 7% over the next decade. Selected specialties will actually decrease in numbers (Thoracic Surgery). US Census bureau estimates a 36% increase in population over age 65 in that same time frame. American Association of Medical Colleges, 2010 10
Healthcare Workforce The AAMC Center for Workforce Studies predicts a shortage of 45,000 primary care physicians and 46,000 surgeons and specialists by the year 2020. One third of the nation s physicians will retire in the next decade Significant limitations on residency programs will inhibit growth in the number of new physicians American Association of Medical Colleges, 2010 11
Healthcare Workforce The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing healthcare. Ingelhart, 2009 12
Healthcare Workforce An expansion of care delivered by physician assistants (PAs) and nurse practitioners (NPs) is often cited as a solution to the predicted surge in demand for health care services with increased calls for an examination of current reliance on these providers. Morgan, Strand, Ostbye, and Albanese, 2007 13
Similar Origins; Distinct professions Both professions were born in 1965 Nurse Practitioners University of Colorado - Pediatric Nurse Practitioner Physician Assistants Duke University -Physician Assistant First Class of PAs Duke 1965 14
Origins Many similarities in scope of practice Important differences in philosophy that underlies education 15
Overview of the Physician Assistant Profession 16
Physician Assistants Over 80,000 PAs are clinically active PAs practice in virtually every medical specialty Practice authorized in all 50 states in the U.S. Over 5,000 new PA graduates enter the workforce each year 17
PA Workforce PA Workforce Doubled in Size in 10 Years United States 2000 2010 Change Total PAs 46,629 95,135 104% Practicing PAs 40,568 83,466 106% Primary Care 20,314 25,930 28% General Surgery 1,079 2,249 108% Pediatric Subspecialties 624 1,345 116% Emergency Medicine 3,795 8,890 134% Internal Medicine Subspecialties 3,198 8,395 163% Surgical Subspecialties 6,903 18,989 175% American Academy of Physician Assistants, 2000 and 2010 18
American Academy of Physician Assistants, 2010 19
American Academy of Physician Assistants, 2010 20
Physician Assistant Compensation American Academy of Physician Assistants, 2010 21
PA Prescribing NH AK WA OR NV CA ID AZ UT MT WY CO NM VT ND MN WI NY SD MI PA IA NE OH IL IN WV VA KS MO KY NC TN OK SC AR AL GA MS TX LA NJ ME MA RI CT DE MD DC FL HI Prescribe including controlled substances Prescribe excluding controlled substances Danielsen, n.d. 22
Regulation and Licensure Each state determines the scope of practice for Physician Assistants in their legislative jurisdiction and defines qualifications for licensure. Most states assign Board of Medicine task of promulgation of regulations for practice within the scope of state law In selected states PAs are regulated by separate PA boards 23
Regulation and Licensure In each state, Physician Assistants must be nationally certified by the National Commission on Certification of Physician Assistants (NCCPA) to apply for licensure 24
National Certification The C in the PA-C NCCPA is the only certifying organization for physician assistants in the United States. Established as a not-forprofit organization in 1975, NCCPA is dedicated to assuring the public that certified physician assistants meet established standards of clinical knowledge and cognitive skills upon entry into practice and throughout their careers. All 50 states, the District of Columbia and the U.S. territories use NCCPA certification as one of the criteria for licensure or regulation of physician assistants. National Commission on Certification of Physician Assistants, n.d. 25
National Certification Once certified, PAs must maintain certification via CME hours every two years and then demonstrate competence every 6 years via recertification examination. Some states may have additional CME requirements to maintain licensure 26
Physician Assistant Education 27
Geographic Distribution of PA Programs as of June 2011 PAEA Twenty-Sixth Annual Report, 2010 28
Highest Credential Awarded by PA Programs PAEA Twenty-Sixth Annual Report, 2010 29
Highest Credential Awarded by PA Programs, 1996-2009 PAEA Twenty-Sixth Annual Report, 2010 30
PA Programs by Year First Class Was Enrolled PAEA Twenty-Sixth Annual Report, 2010 31
PA Program Length (Months) PAEA Twenty-Sixth Annual Report, 2010 32
Prerequisite Courses for Application to PA Programs PAEA Twenty-Sixth Annual Report, 2010 33
Health Care Experience Requirements for Applicants to PA Programs PAEA Twenty-Sixth Annual Report, 2010 34
PA Program Enrollment by Gender PAEA Twenty-Sixth Annual Report, 2010 35
Average Matriculant GPA by Program PAEA Twenty-Sixth Annual Report, 2010 36
Primary Care vs. Non-Primary Care Specialty Choices of 2009 PA Program Graduates PAEA Twenty-Sixth Annual Report, 2010 37
PA Program Graduates Starting Salary, 1989-2009 PAEA Twenty-Sixth Annual Report, 2010 38
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PA Program Accreditation Accreditation Review Commission-Physician Assistant (ARC-PA) Currently 159 PA programs accredited by ARC- PA 40
Overview of the Nurse Practitioner Profession 41
Nurse Practitioner's Over 140,000 NPs are clinically active NPs practice in virtually every medical specialty Practice authorized in all 50 states in the U.S. Over 9,000 new NP graduates enter the workforce each year from over 325 programs 42
Primary clinical specialties of NPs *The number of clinical specialties will exceed the total number for all clinical specialties because each NP may report more than one specialty. National Sample Survey of Registered Nurses, 2008 43
NP Prescribing NH AK WA OR NV CA ID AZ UT MT WY CO NM ND SD NE KS OK TX VT MN WI NY MI PA IA OH IL IN WV VA MO KY NC TN SC AR AL GA MS LA NJ ME MA RI CT DE MD DC FL HI Prescribe independently, including controlled substances Prescribe with some degree of physician involvement, including controlled substances Prescribe with some degree of physician involvement, excluding controlled substances Danielsen, n.d. 44
Annual Salary for Full Time NPs by Population Focus 2011 AANP National NP Compensation Survey 45
Annual Salary for Full Time NPs by Practice Setting 2011 AANP National NP Compensation Survey 46
Regulation and Licensure Each state sets requirements for licensure in state practice act for nursing. Must hold a license as a registered nurse in that state Regulation is usually via Board of Nursing, the exceptions being NC & GA where they are regulated by BOM or joint board. 47
Danielsen, n.d. 48
National Certification Two largest certifying bodies American Nurses Credentialing Center (subdivision of the American Nurses Association) American Academy of Nurse Practitioners Recertification Varies by body i.e. if AANP certified can sit for exam ordo continuing education Many fields of specialty certification 49
Nurse Practitioner Education 50
General Requirements To be educated as a nurse practitioner one must first be qualified as a register nurse. All programs currently at the masters or doctoral level Candidates who were educated (as RNs) at the associate or certificate level may gain admission to a bridge program to first obtain a BS or MSN while proceeding forward 51
Nurse practitioner preparation, by highest nursing or nursing-related degree National Sample Survey of Registered Nurses, 2008 52
University of Pittsburgh - Family Nurse Practitioner Curriculum Doctor of Nursing Practice http://www.nursing.pitt.edu/academics/dnp/curriculum_dnp/family_np_bsn_dnp.jsp 53
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Accreditation Commission on Collegiate Nursing Education (CCNE) National League for Nursing Accrediting Commission (NLNAC) 55
Current Issues Physician Assistant world Name Nurse Practitioner world Degree issue Both worlds Addressing health care needs of system 56
This has been fun thank you Any Questions? 57
Please note I am indebted to Dr. Randy Danielsenfor allowing me to use several of his slides either in their entirety or slightly modified from a presentation entitled Administrative Implications for the Developing ICU Workforce 58
References American Academy of Nurse Practitioners National NP Compensation Survey (2011). Retrieved March 22, 2012 from http://www.aanp.org/nr/rdonlyres/f7e4a2f4-7597-4bf7-8d0f- 97C56BD7FC2D/0/2011AANPNationalNPCompensationSurvey.pdf American Academy of Nurse Practitioners National NP Compensation Survey (2011). Retrieved March 22, 2012 from http://aanp.org/nr/rdonlyres/a1d9b4bd-ac5e-45bf-9eb0- DEFCA1123204/4710/2011FAQswhatisanNPupdated.pdf 59
References American Academy of Physician Assistants. (2011). 2010 AAPA Physician Assistant Census. Alexandria, VA. Retrieved March 22, 2012 from http://www.aapa.org/uploadedfiles/content/research/2010%20ce nsus%20report%20national%20_final.pdf Association of American Medical Colleges Center for Workforce Studies (2010, June). Physician shortages to worsen without increases in residency training. Retrieved March 22, 2012 from https://www.aamc.org/download/150584/data/physician_shortage s_factsheet.pdf 60
References Danielsen, R.D. Administrative implications for the developing ICU workforce. Retrieved March 22, 2012 from http://www.sccm.org/sitecollectiondocuments/credentialing%20% 20Considerations%20for%20the%20Developing%20ICU%20Workfor ce.pdf Danielsen, R.D.; Balweg, R.; Vorvick, L.; Sefcik, D. The Preceptors Handbook for Supervising Physician Assistants. P. 9. Jones & Bartlett. 2011. 61
References Ingelhart J.K. Reform and the healthcare workforce-current capacity, future demand. N. Engl J Med 361(19):e38.2009 Morgan P.A., Strand J., Ostbye T., and Albanese M.A. Missing in action: Care by physician assistants and nurse practitioners in national health surveys. Health Serv Res 42(5): 202-37. 2007 National Commission on Certification of Physician Assistants. Retrieved March 22, 2012 from http://www.nccpa.net/about.aspx 62
References Physician Assistant Education Association. Twenty-sixth annual report on physician assistant educational programs in the united states. Retrieved March 22, 2012 from http://www.paeaonline.org/index.php?ht=a/getdocumentaction/i /135135 US Department of Health and Human Services Health Resources and Service Administration. The registered nurse population: Findings from the national 2008 survey of registered nurses. Retrieved March 22, 2012 from http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf 63
References Retrieved March 22, 2012 from University of Pittsburgh, Pitt School of Nursing Web site: http://www.nursing.pitt.edu/academics/dnp/curriculum_dnp/famil y_np_bsn_dnp.jsp 64