The past year has been punctuated by an ongoing public debate regarding health-care and health-insurance reform. When fully implemented, the recently passed health-care-reform legislation should extend insurance coverage to millions of currently uninsured Americans. Many nurse practitioners and physician assistants are particularly interested in this development since the vast majority of us are primary-care providers. We work long days seeing patients and providing them with high-quality primary-care services, yet we have often been invisible in debates regarding access to primary care.
Our physician colleagues, too, provide high-quality primary-care services across a variety of settings. Each March, the National Resident Matching Program unites fourth-year medical students with residency slots in a variety of postgraduate medical-education programs. The outcome is often worthy of media coverage because the results indicate shortages of primary-care providers and medical students’ desire to enter specialty versus primary-care programs. There are clearly reasons to avoid primary care, not the least of which involve the relatively low salaries and the ever-increasing burden of student debt that new physicians must somehow pay. The shortage of primary-care physicians is a major systemic challenge.
Although there were overall improvements in primary-care specialties this year, nearly 9% of family-practice seats remained unfilled, with a total of 94 family-practice residency programs ending the 2010 match period below capacity. More U.S. medical graduates entered family practice (1,169, compared with 1,071 in 2009), but this represented only 45% of available family-practice residency seats. Clearly, the match rates for family-practice residency programs continue to reflect dynamics within the U.S. health-care market that make a career in primary care undesirable to our medical-school graduates.
This year’s match did generate some good news: Both internal-medicine and pediatric residency programs saw increases in enrollment by U.S. medical graduates (3% and 2%, respectively) over last year. Surgical and specialist residency programs saw a continued trend of near-complete enrollment and very high rates of attendance by U.S. medical graduates. The results of the match are very similar to those seen in past years, and they continue to reflect problems in the primary-care arena.
Given health reform and the probability that the number of covered patients will rise, will we have enough primary-care providers to address our needs? Patient visits will increase as more families gain insurance. Additionally, our current system has demonstrated a highly limited ability to steer U.S. medical graduates into primary-care specialties. NPs and PAs, however, offer a ready solution. Studies have long supported our ability to provide effective health services in primary-care settings. Further, NPs and PAs offer an economically feasible solution, given the lower costs associated with our education and salaries.
While this all seems logical, we have to go the extra mile and force our way into debates regarding health-care reform. We need to make politicians understand, as our patients do, that we offer a cost-effective solution to these problems. We are not a “stopgap” measure to facilitate health-care access while physician work-force issues are addressed. NPs and PAs are, simply put, the solution.