While NJ Spotlight is on winter hiatus, we’ve asked some of the state’s thought leaders to share their opinions and expertise with our community. We’ll be back, rested and ready, next week.
While everyone is preparing to count down the dropping ball in Times Square to welcome in 2012, many of us in healthcare are counting down to the implementation of the Affordable Care Act in 2014. We’re also wondering if we will have enough primary care providers to serve the 600,000 uninsured New Jersey residents who will gain access to healthcare.
With an estimated shortage of 1,600 primary care physicians by 2014, the concerns are growing. Nurses believe there will be enough primary care providers, if the over 3,000 advanced practice registered nurses (APRNs) in New Jersey are allowed to practice to the full extent of their education and licensure.
Fifty years ago seeing your primary care provider meant a trip to your doctor’s office. Today, primary care providers can be physicians or advanced practice nurses — who may be referred to as nurse practitioners, clinical nurse specialists, nurse anesthetists, or nurse midwives. APRNs are registered nurses with at least a master’s degree in nursing. Many programs are now developing doctoral programs, which require candidates to sit for a certification examination with the national APRN association and take the required continuing education courses to be licensed in their states. In New Jersey the Nurse Practice Act mandates a joint protocol governing prescription drugs and drug-administering devices signed by the APRN and the APRN’s designated collaborating physician.
Approximately 70 percent to 80 percent of APRNs are engaged in primary patient care. According to the 2009-2010 AANP National NP Sample Survey in 2009, there were approximately 135,000 NPs practicing in the U.S.; the most common specialty areas for practicing NPs were family practice (42 percent), adult practice (21 percent), pediatrics (9 percent), women’s health (10 percent), and acute care (7 percent). These APRNs may run clinics in the inner city, manage a solo private practice, work on a multidisciplinary team in a facility, or work within a school setting — to name a few possibilities.
The Kaiser Family Foundation March 2011 publication, Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants, noted that sixty-five million people live in areas designated by the federal government as having a shortage of primary care providers.
The publication goes on to note:
“NPs are also, by far, the fastest-growing segment of the primary care professional workforce; between the mid-1990’s and the mid-2000’s, their numbers (per capita) grew an average of more than 9 percent annually, compared with about 4 percent for PAs and just 1 percent for primary care physicians. Primary care NPs work in diverse clinical settings, including physician practices, health centers, managed care organizations, retail or convenient care clinics, and school-based health centers. They are a key source of primary care in community health centers and in 250 nurse-managed health clinics across the country, which serve about 20 million patients a year. According to one account, about 10,000 NPs run their own practices.”
So what are the obstacles to fully engaging these APRNs to fill the primary care gap?
While the New Jersey State Nurses Association (NJSNA) is working to change these antiquated laws and policies, it is important to know how APRNs will help fill the primary care gap:
Before the ball drops on New Year 2014 and the Affordable Care Act creates an opportunity for millions of people who have not had healthcare coverage, we in New Jersey better be ready. Yes, we need more primary care physicians, but there is nothing we can do to fill the 1,600-physician gap by 2014. We can, however, remove obstacles to APRN practice and we can create programs to encourage APRNs to stay in New Jersey and practice in primary care. These things we can and must do by 2014. Happy New Year!