The perfect storm is brewing in health care. A "silver stampede" of baby boomers is both forcing aging doctors to retire and patients to need more care, and millions of the uninsured are soon to enter the system. Primary care will be in great demand, but the doctor well is running dry thanks to a growing shortage. Can nurses fill the void?


I'm working on a feature for our December issue about the growing physician shortage — the Association of American Medical Colleges says the shortfall in primary care will grow to about 45,000 by 2020 — and one possible solution. Doctors can't get through school fast enough to squelch the shortfall. So experts, such as David Auerbach, a health economist with the RAND Corp., are foreseeing a growing role for the nurse practitioner.

"Everybody in policy has drunk the Kool-Aid of primary care is good, and if you're a health system, investing in better primary care could very well save you money in the long run," he told me by phone next week.

A recent study by RAND, a nonprofit focused on research and analysis, found that nurse practitioners are surging in supply. These nurses — who can provide a wide range of preventative and acute health care services, are authorized to practice across the nation, and have prescriptive privileges of some degree in 49 states — total about 155,000 currently. Auerbach estimates that the NP workforce will swell to 244,000 by 2025, a near doubling from 2008 numbers.

Some hospitals and health systems are putting NPs at the forefront, having them lead nurse-managed health care centers, of which Auerbach estimates there are about 200 in the country. He also points out that these clinicians are a critical part of more coordinated care models, such as accountable care organizations and patient-centered medical homes. If the use of such models continues to take hold, NPs will be in growing demand, he says.

Not everyone in health care, however, thinks that nurse-led care is the solution to helping solve the physician shortage. The American Academy of Family Physicians released a report last month, questioning the use of a nurse practitioner to replace a physician. In it, the organization points out that NPs receive about five and a half to seven years of education, compared with doctors' 11.

"The rationale behind most proposals to allow nurse practitioners to practice independently is that the nation is facing a primary care physician shortage. This is true," the report states. "But substituting NPs for doctors cannot be the answer. Nurse practitioners are not doctors, and responsible leaders of nursing acknowledge this fact."

Instead, the AAFP says, the nation should continue shifting to team-based care in medical homes, with an ideal ratio of four NPs for every one doctor.

The American Academy of Nurse Practitioners fired back shortly thereafter, saying that health care must embrace all different models of health care to try and relieve the physician shortage. "More than 100 studies analyzing care provided by both NPs and physicians have demonstrated that NPs have the same or better patient outcomes when compared to physicians," according to the AANP. "Making full use of the NP workforce is a critical piece of a multi-pronged solution to address the urgent need for health care access in our nation."

What is your hospital's strategy for deploying nurse practitioners? Are they becoming a growing part of your team, as RAND anticipates, or are you cautious to give them to much control, for fear of stirring up a hornets' nest? Comment below, and tell us your stories.