With numbers indicating a physician shortage, especially in rural areas, physician groups are looking to tap a potentially underutilized group: Nurse practitioners, or advanced practice clinicians, whose numbers are actually on the rise.
David Fairchild, a physician and director of BDC Advisors in Massachusetts, said APCs have traditionally been considered a supporting role in the delivery of care. But that attitude is shifting. Speaking at the Healthcare Financial Management Association's annual ANI conference in Orlando, Fairchild said what makes sense in this environment is to divvy up work based on what's appropriate for whom. In that way, APCs can help fill the gap, particularly in rural areas and smaller markets.
And the gap is growing. Based on current projections, Fairchild said it's likely that there could be a shortage of 20,000 to 30,000 physicians by 2025, and potentially as many as 53,000. By contrast, the ranks of those training to be nurse practitioners, now representing 19 percent of all medical trainees, is expected to swell to 29 percent over the next ten years, based on research by the journal Health Affairs.
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"We're moving to a day when nurse practitioners are going to be able to practice on their own," said Fairchild. "We want them to be able to be independent clinicians. That's the way the current is going."
To highlight what some physician groups are doing to make that happen, Fairchild cited North Mississippi Health Services, which serves 24 mostly rural communities in Northern Mississippi and parts of Alabama. Their response has been to form clinically integrated networks.
In 2016 they said, "We're starting to feel pressures we've never felt before. Population health is around the corner, we're going to have to deal with value-based contracts pretty soon, and we need to get physicians in the community aligned with us so they don't get picked off by competitors who want to form a physician alliance."
The clinically integrated network they formed was essentially a new corporation that focused on pulling in independent providers.
"The nice thing about a CIN is it allows a safe harbor from the Federal Trade Commission," said Fairchild. "If the purpose of the company is to improve quality, reduce costs and improve the patient experience, the FTC says you can work together as a clinically integrated network to improve the quality of care and basically do population health."
Erik Dukes, MD, regional medical director for North Mississippi Health Services, said the formation of the CIN was a perfect storm.
"Where we are in this system is where we're going nationally," said Dukes. "The nurse practitioners were operating almost independently. The CIN is working to provide a better value at lower cost, with higher quality for the people in our system."
The steering committee that developed the CIN noticed that APCs felt like hired hands. It tried to keep the CIN from being a typical physician group, opting for openness and transparency, and a spot on the board for a nurse practitioner.
"We wanted to be the preferred care partner for APCs in the region," said Dukes. "We started developing credibility among them, and we started to use our own APC for recruitment."
The committee clarified clinical protocols for different levels of training, determining who would be capable of handling what, and embarked on a listening tour to gather ideas from APCs to make them feel more valued and more connected.
It's early in the process to quantify the results of these efforts but Dukes said the APCs are grateful to be included, and attitudes among physicians have remained largely unchanged.
"We have to have APCs as a cog in the wheel," said Dukes. "It's a collaboration that continues to grow and change. Independent physicians are a dying breed and the number of primary care physicians is falling. APCs are rising up to fill that gap."