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Primary care workforce paradox: A physician shortage and a PA and NP surplus
Ryan White1, David Keahey, Morgan Luck
1Ryan White is an assistant professor and assistant director of clinical education and practice in the PA program at Rutgers University School of Health Professions in Piscataway, N.J. David Keahey is chief of policy and government relations at the Physician Assistant Education Association in Washington, D.C. Morgan Luck is an associate professor in the PA program at Shenandoah University in Winchester, Va. Richard W. Dehn is a professor in the College of Health and Human Services at Northern Arizona University's Phoenix Biomedical Campus, a professor in the Department of Biomedical Informatics at the University of Arizona College of Medicine in Phoenix, and editor-in-chief of JAAPA . The authors have disclosed no potential conflicts of interest, financial or otherwise.
Objective:
Primary care workforce projections continue to predict significant physician shortages. An oversupply of primary care physician assistants (PAs) and NPs also is predicted. This paradox calls into question the assumptions that underlie workforce projection models, which likely underestimate the primary care contributions of PAs and NPs.
Methods:
Federally qualified health center data from the 2016-2019 Uniform Data System were used to calculate the number of clinic visits per full-time equivalent (FTE) physician, PA, and NP. Visits per FTE were compared across provider type to determine provider-specific productivity ratios.
Results:
The combined PA and NP productivity ratio increased relative to physicians in each year, ranging from 0.85 in 2016 to 0.88 in 2019. Clinic visits per FTE for PAs and family physicians were nearly equivalent.
Conclusions:
Primary care workforce projection models should be reexamined to more accurately capture the productivity of PAs and NPs.
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