Sharp increase expected in number of nurse practitioners

( The nurse practitioner population will nearly double by 2025, according to an analysis published in the July Medical Care, the official journal of the medical care section of the American Public Health Assn.

“Nurse practitioners really are becoming a growing presence, particularly in primary care,” said David I. Auerbach, PhD, the author and a health economist at RAND Corp.

Auerbach used modeling to project that the count of those trained as nurse practitioners would increase 94% from 128,000 in 2008 to 244,000 in 2025. The subgroup of those providing patient care as nurse practitioners, rather than filling administrative or other roles, will rise 130% from 86,000 in 2008 to 198,000 in 2025.

Other research has found significant growth in the number of nurse practitioners and other midlevel clinicians and indicated that more physicians are working with them. According to the annual census by the American Academy of Physician Assistants, 40,469 physician assistants were practicing in 2000, and that number went up 106% to 83,466 in 2010. A data brief released Aug. 17, 2011, by the Centers for Disease Control and Prevention’s National Center for Health Statistics found that 49% of office-based physicians worked with physician assistants, nurse practitioners and/or certified nurse midwives.

Experts who study health care work force issues believe that midlevel practitioners are becoming more common because the medical system is looking for more efficient ways to use physicians, who can be in short supply. There is also a need to meet the growing medical demands of an aging population. A December 2008 report on the physician work force by the Health Resources and Services Administration found that the U.S. would need 976,000 physicians by 2020, but only 926,600 would be available to provide care.

The number of physician assistants in the U.S. more than doubled from 2000 to 2010.

“There’s a lot of experimentation going on looking at different ways of working together, and there’s a lot of interest in collaborative team-based models,” Auerbach said. “The new care models such as the patient-centered medical home and accountable care organizations really depend on nurse practitioners and physician assistants.”

Nurse practitioners are being viewed as a possible solution because training someone for this occupation takes less time than for a physician. Becoming a nurse practitioner usually involves licensure as a registered nurse, work experience and a one- to three-year master’s program, although some receive a doctorate degree. Becoming a physician takes four years of medical school and a three- to seven-year residency. Some subspecialties may require an additional one- to three-year fellowship.

Another factor in the growth is that the number of nurses is growing faster than work force expansion. The Bureau of Labor Statistics projects that the number of jobs for any type of nurse, including NPs, will increase 26%, from 2,737,400 positions in 2010 to 3,449,300 in 2020. Average growth for any occupation in this time frame is 14%. In 2011, the average nurse practitioner earned $90,583, according to the annual survey by Advance for NPs & PAs, a monthly journal for midlevels.

“People have gotten the message that becoming a nurse, and especially an NP, is a very good, solid career choice,” Auerbach said. “And the salaries are pretty high.”

Many physician organizations, including the American Medical Association, support the inclusion of nurse practitioners and physician assistants as part of a care team, but say they should practice with physician supervision or collaboration.