Image: iStock
Image: iStock
The continuing shortage of primary care physicians is expected only to get worse as the expansion of health coverage under the Affordable Care Act increases 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.
While several physician groups have opposed the perceived replacement of physicians with nurse practitioners as primary care clinicians, a recent survey found 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 was published in Academic Medicine. Senior author Karen Donelan, HMS assistant professor of medicine at Massachusetts General Hospital, said 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,” Donelan said. “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 they are better paid. We need a national dialogue that will ensure that the public can access primary care services provided by clinicians whose roles and skills are clear.”
Lead author Catherine DesRoches, formerly of the Mongan Institute for Health Policy at Mass General and now at Mathematica Policy Research, added, “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 primary care practice and the overall quality of services provided by the two types of professionals. The current paper reports on respondents’ perceptions concerning the supply of primary care clinicians in the U.S., their satisfaction with their current employment and their careers in general, and on their opinions regarding whether qualified high school or college students should pursue careers as primary care physicians or as nurse practitioners.
More than 80 percent of both groups agreed that there is a national shortage of primary care physicians, and 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 and 63 percent would recommend a career as a nurse practitioner.
“It is unsettling that so many primary care physicians are unwilling to recommend careers in primary care medicine,” said study co-author Peter Buerhaus, the Valere Potter Professor of Nursing at the Vanderbilt University School of Nursing. “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.”
The study 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.
Adapted from a Mass General news release.
