Nurse practitioners and physician assistants will be needed to fill the current and projected workforce shortages in the management of patients with cardiopulmonary disease, according to the results of a study published in Chest. The gaps exist between the availability of providers and patients with cardiopulmonary disease across major healthcare settings, including ambulatory, critical care, and postacute care, as well as several cardiopulmonary specialty areas.

Researchers conducted a systematic review of medical databases from studies published from 2006 to 2016. The search used terms including personnel, staffing, workforce, workload, shortages, and healthcare settings. A total of 15 identified studies were included that related to the potential workforce gap. Of the 15 studies, a total of 2 categories were identified: workforce shortages and recommendations for workforce solutions.

The researchers found published evidence of current and projected workforce shortages in all clinical settings where care of persons with cardiopulmonary disease occurs. Current workforce shortages stem from patients experiencing increased wait times and physicians not taking on new patients. Data also suggest there will be cardiopulmonary workforce shortages throughout medical specialties, including pediatric pulmonary care, sleep medicine, care for circulatory disorders, cardiopulmonary medicine, ambulatory medicine, critical care, and postacute care settings.

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One example of the effect of current workforce shortages is an underdiagnosis of obstructive sleep apnea in patients with diabetes, noted the investigators. “[I]t can be inferred that the cost of untreated [obstructive sleep apnea] in this population, including myocardial infarction and stroke, may increase with the increasing age of the population,” they noted.

Solutions to the workforce shortages included increasing physician training in medical specialties and the integration of nonpyhysician advanced practice providers (APPs) into the medical team. Possible solutions to improve use of the existing workforce in critical care include the use of telemedicine/telehealth and care regionalization and cross-training the physician and APPs in the basic components of critical care to meet staffing needs of lower-acuity hospitals in regionalized, acuity-based, tiered systems.

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“A frequently cited solution in the literature was to use APPs to fill these gaps,” the authors concluded… “Improving preparatory training of current APPs or expanding the APP role to specifically trained APP providers with cardiopulmonary disease are options that alleviate the identified workforce gap.”


Joyner RL Jr, Strickland S, Becker EA, et al. Adequacy of the provider workforce for persons with cardiopulmonary disease [published online October 14, 2019]. Chest. doi:10.1016/j.chest.2019.09.030