The continuing shortage of primary care physicians is expected to only worsen, as the expansion of health coverage under the Affordable Care Act increases the demand for primary care services. Recommendations for meeting the crisis have included both increasing the supply of primary care physicians and expanding the roles of primary care nurse practitioners. But while several physician groups have opposed the perceived replacement of physicians with nurse practitioners as primary care clinicians, a recent survey finds that more physicians would recommend that qualified students pursue careers as nurse practitioners than as primary care physicians. The report from a multi-institutional research team has been published online in Academic Medicine.
Senior author Karen Donelan, ScD, EdM, of the Mongan Institute for Health Policy at Massachusetts General Hospital, indicates that the findings reflect the need for greater clarity about the roles of primary care clinicians. "Our data have shown that primary care physicians and nurse practitioners are being educated in very different ways to provide similar types of clinical services. Nurse practitioners report much greater career satisfaction, work fewer hours and have more time with patients. Primary care physicians appear more beleaguered and work longer hours but are better paid. We need a national dialogue that will assure the public can access primary care services provided by clinicians whose roles and skills are clear.”
Lead author Catherine DesRoches, DrPH, formerly of the Mongan Institute and now with Mathematica Policy Research, adds, “These findings suggest that solving the primary care clinician shortage will require more than simply training a greater number of physicians. Efforts should be aimed at reimagining how the entire primary care workforce should be structured, with one goal of the process being an increase in primary care physicians’ career satisfaction. Without a significant shift in how these clinician’s view their careers, efforts to bolster the workforce are likely to fall short.”
Conducted in 2012-13, the survey was mailed to a national random sample of nearly 2,000 primary care clinicians – evenly divided between physicians and nurse practitioners. Responses were received from 467 nurse practitioners and 505 physicians. A previous analysis from the survey, published in the New England Journal of Medicine, reported on significant differences in how primary care physicians and nurse practitioners view the scope of practice and the overall quality of services provided by the two types of professionals. The current paper reports on respondents’ perceptions regarding the supply of primary care clinicians in the U.S., their satisfaction with their current employment and their careers in general, and whether they would recommend that qualified high school or college students pursue careers as primary care physicians or as nurse practitioners.
While more than 80 percent of both groups agreed that there is a national shortage of primary care physicians, both types of professionals were more likely to recommend a career as a nurse practitioner than as a physician. Although 56 percent of primary care physicians did recommend their own career, 66 percent would recommend careers as primary care nurse practitioners. Among nurse practitioners, 88 percent would recommend that students pursue their own career, while 67 percent would recommend careers as primary care physicians.
The likelihood that physicians would recommend primary care careers in advanced practice nursing rather than medicine appears to be influenced more by their own career satisfaction than by their perceptions about the supply of physicians. While the majority of primary care physicians indicated being satisfied with their current employment and career choice, among the almost half who indicated being somewhat satisfied or dissatisfied with their career choice, only 37 percent would recommend careers as primary care physicians, while 63 percent would recommend a career as a nurse practitioner.
Study co-author, Peter Buerhaus, RN, PhD, Valerie Potter Professor of Nursing at the Vanderbilt University School of Nursing, adds, “It is unsettling that so many primary care physicians are unwilling to recommend careers in primary care medicine. Most physician-oriented policy initiatives today are aimed at increasing the supply of physicians rather than targeting factors that affect physician work satisfaction. It is a waste of valuable resources to concentrate only on expanding physician supply and ignore changing the practice environment to promote a more satisfied primary care physician workforce. After all, interactions with physicians can exert a tremendous influence on shaping career preferences and decisions among young people.”
Robert Dittus, MD, MPH, of the Veterans Administration Tennessee Valley Geriatric Research, Education and Clinical Center and Vanderbilt Institute for Medicine and Public Health, is also a co-author of the study, which was supported by grants from the Gordon and Betty Moore Foundation, the Johnson & Johnson Campaign for Nursing’s Future, and the Robert Wood Johnson Foundation.
Mathematica Policy Research seeks to improve public well-being by conducting studies and assisting clients with program evaluation and policy research, survey design and data collection, research assessment and interpretation, and program performance/data management. Its clients include foundations, federal and state governments, and private-sector and international organizations. The employee-owned company – with offices in Princeton, N.J.; Ann Arbor, Mich.; Cambridge, Mass.; Chicago, Ill; Oakland, Calif; and Washington, D.C. – has conducted some of the most important studies of health care, international development, disability, education, family support, employment, nutrition, and early childhood policies and programs.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $785 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine.
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