Filling the Gap Wisely
Nurse Practitioner Workforce
There is no question that healthcare costs have been weighing heavy on policy makers, especially with an aging 'baby-boom' generation and passage of the Patient Protection and Affordable Care Act (ACA) of 2010. Total national spending on healthcare was estimated to have exceeded $2.8 trillion in 2012, which represented 17.9% of the gross domestic product (GDP) (Turner and Hughes-Cromwick, 2013). Given its current trajectory, healthcare spending could reach $4.8 trillion by 2021 and consume nearly 20% of GDP (CMS, n.d.).
However, not everyone considers healthcare spending to be out of control. Rather than rely solely on percent GDP, Turner and Hughes-Cromwick (2013) looked at spending as percent potential GDP (PGDP). PDGP is considered a better long-term reference for economic trends because it minimizes fluctuations caused by short-term changes in inflation. Based on this
healthcare spending is currently around 17.0% of PGDP, but more importantly, annual increases in healthcare spending reached all time lows in 2009 and 2010. In fact, annual increases in healthcare spending declined from 10% to 4% between 2002 and 2008 and have stabilized between 4% and 6%. These findings suggest that U.S. healthcare spending relative to the consumer price index (CPI), an accepted measure of inflation, had stabilized by 2008 and has been only 1-3% above the CPI since (Inflation.eu, 2013).
Using out-of-control healthcare costs as an argument for increasing the role of nurse practitioners (NPs) may not be sufficiently convincing in light of the above findings. Another argument that has received some attention is an increasing physician shortage (Bell, 2012). A recent policy recommendation by the Association of American Medical Colleges (AAMC, 2012) predicts that unless Congress enacts emergency legislation to remove the annual cap on residency training, the additional 300 positions funded under the ACA cannot meet the additional 10,000 needed to meet the demand. With 32 million Americans suddenly becoming eligible for healthcare coverage under the ACA and an aging 'baby-boom' generation, the doctor shortage is expected to reach 91,500 by 2020.
In 2010 there were approximately 106,000 NPs in the U.S., of which 52% were working in primary care (AHRQ, 2011). By comparison, there were approximately 560,000 primary care physicians (BLS, 2012a). Since numerous studies have found that NPs provide care quality equivalent to physicians (Newhouse et al., 2011), the looming physician gap could be moderated by an increase in the size of the NP workforce.
Increasing the NP workforce to minimize the effects of the doctor shortage would also have economic…
