If the Association of American Medical Colleges' prediction comes true— that the nation's physician shortage will grow from about 25,000 today to about 150,000 in 15 years—who will treat the millions more people who will have health coverage for the first time under health reform?
Some of this care is almost certain to come from non-physician providers expanding their education and scope of practice, a push that's either a battle or a gentle nudge to a greater or lesser degree in every state and many medical professions nationwide.
"In my view, what we're seeing is a kind of an evolution of most of the professions moving toward an expansion of their scope of practice," says Stephen Collier, director of the Office of Health Professions Education and Workforce Development at the University of Alabama at Birmingham. Collier sees it not so much as health professions waging a turf battle, but a change taking place because health reform laws are demanding we rethink public policy.
"It's a kind of a natural thing as [the U.S. healthcare system] tries to provide more services," he says.
Clearly physician groups may be vehemently opposed to expanded purviews of other health professions, saying that subordinate health providers don't have the necessary training and skill to diagnose and treat complex diseases. At the very least, a physician needs to be in the room or immediately available.
But the move is on to fight that attitude—out of necessity, many professional trade organizations say. For example, advanced practice nurses are working for expanded ability to prescribe drugs, admit patients to hospitals, and practice in office settings with minimal or perhaps no physician oversight.
"They've gone to school for a minimum of six years, just about as long as physicians do," says Rebecca Patton, president of the American Nurses Association, who says that nurse practitioners are being increasingly employed by hospitals to do tasks that residents can no longer perform because of limits on their work hours.
Bernadine Healy, MD, former director of the National Institutes of Health, wrote in a recent U.S. News and World Report article that nurses "have broken the bounds of their crisp white aprons to assume substantial authority," to treat "a wide range of common medical conditions and wield a prescription pen with virtually the same independence as any MD."
The country simply lacks "sufficient primary care doctors to attend to the growing ranks of aging baby boomers and patients of all stripes who increasingly demand support with wellness and disease prevention," she wrote.
Many organized health professions are taking steps to work without physician oversight, something that is important in rural and underserved areas where physician recruitment continues to lag.
Nurse anesthetists are a good example. In 15 states, they now have the ability to be federally reimbursed when they administer anesthesia to Medicare patients without physician supervision, despite objection from the American Medical Association and many state physician groups.