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PERSPECTIVE
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Growing Ranks of Advanced Practice Clinicians
n engl j med 378;25 nejm.org June 21, 2018
Growing Ranks of Advanced Practice Clinicians
Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce David I. Auerbach, Ph.D., Douglas O. Staiger, Ph.D., and Peter I. Buerhaus, Ph.D., R.N.
Throughout the history of mod-ern American medicine, phy- sicians have made up the vast majority of professionals who di- agnose, treat, and prescribe medi- cation to patients. Although de- mand for medical services has increased markedly over the years (and is projected to grow more rapidly as the population ages), the physician supply has grown relatively slowly. Increased dele- gation of work, new technology, and streamlined care processes can help practices meet patient needs with fewer physicians, but still require an increasing num- ber of health professionals.1
Physician supply is constrained in the short run by long training times and in the longer run by medical school capacity and the number of accredited residency positions. Despite a 16% increase in graduate medical education (GME) slots in recent years, the Association of American Medical Colleges (AAMC) recently project- ed that the supply of physicians will increase by only 0.5% per year between 2016 and 2030.
A growing share of health care services are being provided by ad- vanced practice registered nurses (APRNs), particularly nurse prac- titioners (NPs), who make up the majority of APRNs, and by physi- cian assistants (PAs). NPs and PAs provide care that can overlap with care provided by physicians (both in primary care and increasingly in other specialties), and the AAMC recognizes this overlap in its physician-demand forecasts. The number of NPs and PAs is
growing rapidly, in part because of shorter training times for such providers as compared with phy- sicians and fewer institutional constraints on expanding …
