Gaps in the Supply of Physicians, Advance Practice Nurses, and Physician Assistants

BACKGROUND: Based on the goals of health care reform, growth in the demand for health care will continue to increase the demand for physicians and, as physician shortages widen, advanced practice nurses (APNs) and physician assistants (PAs) will play larger roles. Together with physicians they constitute a workforce of “advanced clinicians.” The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services. STUDY DESIGN: Projections were constructed to the year 2025 for the supply of physicians, APNs, and PAs, and these were compared with projections of the demand for advanced clinical services, based on federal estimates of future spending and historic relationships between spending and the health care labor force. RESULTS: If training programs for APNs and PAs grow as currently projected but physician residency programs are not further expanded, the aggregate per capita supply of advanced clinicians will remain close to its current level, which will be 20% less than the demand in 2025. Increasing the numbers of entry-level (PGY1) residents by 500 annually will narrow the gap, but it will remain
15%. CONCLUSIONS: The nation faces a substantial shortfall in its combined supply of physicians, APNs, and PAs, even under aggressive training scenarios, and deeper shortages if these scenarios are not achieved. Efforts must be made to expand the output of clinicians in all 3 disciplines, while also strengthening the infrastructure of clinical practice and facilitating the delegation of tasks to a broadened spectrum of caregivers in new models of care. (J Am Coll Surg 2011; xx:xxx. © 2011 by the American College of Surgeons) As the United States adapts to health care reform, it confronts a series of future uncertainties. How much health care will there be, who will pay for it, who will receive it, and who will provide it? Of particular importance to physicians is the last; will there be enough doctors to provide the necessary care?1 This question is especially germane to surgeons, whose numbers are projected to fall short of the future needs for surgical care2,3 not only in general surgery,4 where projected shortages are severe, but in specialties such as oncologic and orthopaedic surgery, where the demand for services continues to increase.5,6 During the past several decades, others who provide first-contact care have shared care, to an increasing degree, that was once the exclusive province of physicians.7,8Therefore, in assessing the adequacy of the future physician workforce, we broadened our analysis to include other licensed and regulated health professions that have the prerogatives to see a patient without referral and to make and communicate a diagnosis with or without physician supervision. Excluding dentists, psychologists, and clinical social workers, there are only 7 such disciplines.9The majority are either advanced practice nurses (APNs) or physician assistants (PAs), and optometrists, podiatrists, and practitioners of alternative and complementary medicine constitute the rest.10 Together with physicians, these other licensed disciplines constitute a workforce of approximately 1.0 million clinicians, 90% of whom are physicians, APNs, or PAs. Our study considered these 3 disciplines as a single, albeit varied, workforce of “advanced clinicians” who will carry out a definable range of tasks and responsibilities.11 To gauge the future supply of physicians and other advanced clinicians against the future demand for service