The expanding number of nonphysician clinicians

Physician assistant (PA) training was also developed in the 1960s to address a shortage of physicians in primary care and in rural areas. There are approximately 44,000 PAs in the United States, practicing autonomously but in partnership with physicians. Most practice primary care (55%), whereas others specialize in surgical fields such as orthopedics and cardiovascular surgery, hospital care, and dermatology. Their numbers are expected to reach 53,200 by 2005 and 79,000 by 2015.122

By 2015, there will be an estimated 275,000 nurse practitioners, PAs, and nurse midwives, and 100,000 other nonphysician clinicians practicing in psychology, anesthesiology, and optometry.

Their growth is projected to be 15% of the physician workforce, yet insufficient in number to meet the demand for physician services.

The expanding number of nonphysician clinicians can be expected to only partially alleviate projected physician shortages, principally in primary care, whereas the greater demand will be for specialty services. Physician shortages have resulted in part from mistaken projections of oversupply and subsequent reductions in federal funding for physician training.

By 2020, this deficit is projected to reach 200,000 physicians, exceeding shortages experienced during the 1960s.

Concerns over increasing health care spending have also favored the expanded use of nurse practitioners and PAs as an alternative to the care provided by physicians. However, despite lower comparative salaries, nonphysician providers may not be any more successful at limiting patient demand for services and treatments than physicians have been.

Indeed, it has been estimated that the use of nonphysician providers with the same clinical privileges will not result in reduced expenditures but rather will contribute to rapidly escalating medical costs.

Moreover, the necessarily briefer duration of training for nurse practitioners and PAs appears to be at odds with the simultaneous need and demand for added geriatric education.
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