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Nurse Practitioners, Physician Assistants Fill Void

For tens of millions of Americans, the most familiar primary care provider is not a doctor, but a nurse practitioner or physician assistant. A growing number of these health professionals practice alone or with nonphysician colleagues at community clinics, urgent care centers, clinics attached to retail pharmacies, school clinics, workplace health centers and their own offices.

“Anything you can see in primary care, we see here,” said Erin Bagshaw, a nurse practitioner who’s been working solo in an office across the street from the National Zoo in Washington for five years. “We diagnose and see patients with heart disease, cancer, diabetes. We see everyone and charge them the same thing for the same service, except that most pay their bills up front and get reimbursed from their insurance if they have it.”

The District of Columbia is one of 13 jurisdictions where nurse practitioners can diagnose, treat and prescribe without a supervising doctor. Two years ago, Bagshaw became the first private practice nurse practitioner in Washington to be granted staff privileges at a local hospital.

“What’s different from most practices is that I get to spend more time with my patients – 45 minutes to an hour for a first visit, a half hour for most follow-ups,” she said. “But I’m still able to manage a caseload of about 3,000 patients, maybe because I devote a little more time to educating them and keeping them well.”

Bagshaw says with some pride: “I’m a little old-school.” She still uses paper medical records and a fax machine, rather than electronic records.

Jan Towers, a nurse practitioner for more than 30 years who leads the government affairs offices of the American Academy of Nurse Practitioners said: “Unlike a lot of doctors in primary care, we still like what we do. There’s a lot less burnout among our practitioners, and I think a lot of that has to do with how we practice, that we can take time with patients and do more prevention and screening at each visit.”

Government surveys count more than 140,000 advanced practice nurses and 70,000 physician assistants providing clinical care – compared to just over 300,000 primary care doctors.

“That ratio is skewing more toward PAs [physician assistants] each year since the PA workforce is increasing faster than that of physicians,” said Perri Morgan, director of physician assistant research at the Duke University Medical Center. “PAs will be playing a bigger role in the future in primary care and in medical and surgical specialties as well.”

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