The emphasis on cost effective and collaborative care has taken center stage in the health care reform debate and has resulted in an increased demand for both physician assistants and nurse practitioners in the health care community.

“What we are seeing in Colorado is that some health care facilities are reversing the pyramid. Where there used to be a greater demand for MDs, now health care facilities are looking to hire more PAs,” Anita Duhl Glicken, MSW, associate dean of physician assistant studies and director of the Physician Assistant Program at the University of Colorado School of Medicine in Denver, said in an interview.

The healthcare paradigm is shifting, according to Duhl Glicken. “MDs will care for the most complex patients and deal with overall practice management issues. PAs and NPs will be used more extensively to provide the bulk of primary care practice.”

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A variety of medical specialists are also seeking out the services of PAs, with health care providers in this branch stepping up recruitment efforts at PA schools.  “Health care reform has brought attention to the profession, and it has really stimulated a lot of thought on the part of people who had not considered hiring a PA before as to how this can help in practice,” Duhl Glicken said.

Other changes, such as legislation granting more independence to NPs, are also evidence of the need for a more collaborative, cost-effective health care model. The American Academy of Nurse Practitioners noted in a 2010 report that NPs have been providing “equivalent or improved medical care at a lower cost than physicians,” since 1981.1

In a separate report issued by the Institute of Medicine and the Robert Wood Johnson Foundation in Oct. 2010, a joint committee proposed that nurses “act as full partners with physicians and other health professionals,” to meet America’s health care needs.2 They added that nurses should “be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.

The key message is that nurses offer high quality care and can improve the health of individuals, families, and populations in America. The report states that nurses “must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards and political and business arenas, both within nursing and across the health professions.”

It is clear that in the future both PAs and NPs are positioned to play more prominent and expanding roles in the provision of healthcare to Americans.

Susan Schooleman is a freelance medical writer living in the greater Denver area.


1.  American Academy of Nurse Practitioners. “Nurse practitioner cost effectiveness.”

2. Institute of Medicine Committee on the Robert Wood Johnson Foundation

Initiative on the Future of Nursing. “The future of nursing: Leading change, advancing health.”