A recent Associated Press story indicated that nationwide there are 631 people for every primary care physician in America! As you probably know, uneven distribution of the existing primary care physician supply makes the shortage more acute in many, generally rural, areas of the country. For example, the AP article highlighted one rural Georgia county where the ratio of people to primary care physicians was 1,078 to one—and another where it was a staggering 5,791 to one.

Considering our increasing rate of healthcare utilization and a continuing downward trend in medical students’ choosing generalist medical careers, we were unlikely to have resolved the primary-care physician shortage in the next decade even before federal healthcare reform became law in early 2010.

As validation from the locum tenens perspective, industry data indicate that in 2010 approximately 20 percent of requests for locum tenens physicians nationwide were in primary care. In fact, a quick search of one large physician job board indicates that as summer 2011 begins, US healthcare facilities are looking to fill almost 10,000 locum tenens family practice physician jobs alone!

Expanding Demand
Meanwhile, the Patient Protection and Affordable Care Act has begun shifting the clinical community’s focus from disease management to disease prevention and health management. Establishing the prevention paradigm likely will require even more primary-care resources than Americans have accessed in the past.

As implementation of federal healthcare reform adds approximately 32 million previously uninsured Americans to the health-insured population by 2019, I predict that the demand for primary care will increase dramatically.

So how will your already-strained healthcare system or facility accommodate the exponentially expanding demand for primary healthcare services under federal healthcare reform?

Interestingly, when Thomson Reuters recently asked almost 3,000 physicians where most of these newly insured people would find care, 55 percent of responding physicians said nurse practitioners or physician assistants would provide it. (In January 2011, Thomson Reuters released a survey of 2,958 physicians of varying specialties from 50 states plus Washington, D.C., conducted via fax, regarding their views about healthcare reform.)

Although you might think this sounds a bit strange, the survey results appear to be consistent with the team-based model for primary healthcare delivery envisioned by authors of our new healthcare reform law. In fact, this new primary-healthcare delivery model puts the patient, rather than the physician, at its center, requiring what one healthcare policy organization termed a “transformational shift” in how healthcare is delivered.

Nevertheless, assuming that such a radical shift can be accomplished, it could begin to address primary-care access problems, create better coordination of care, and improve patient outcomes.

Promising Population
It’s not surprising, then, that the “physician extenders” I described in my last column are expected to play a larger role in the evolving healthcare landscape.

A cursory look at the locum tenens industry situation today, however, indicates that while physician extenders are part of the solution—with more than 1,200 nurse practitioner jobs and more than 1,000 physician assistant jobs posted on that same large physician job board as summer begins—total demand for them doesn’t even come close to overtaking demand for family practitioners, much less demand for physicians in other categories of primary care practice.

Yet your potential for maximizing benefit from a relatively limited primary-care physician base by supplementing from a growing physician-extender population looks promising.

Ready Reinforcements
The American Academy of Nurse Practitioners reports that approximately 88 percent of nurse practitioners are prepared in primary care, and some 68 percent practice in at least one primary care site. Just under half of the more than 135,000 nurse practitioners practicing in the United States work exclusively in family practice, with roughly another 20 percent practicing in other primary care fields. Most prescribe medications, including those for controlled substances in 48 states.

The AANP defines nurse practitioners’ scope of practice as ‘emphasizing health promotion and disease prevention, in addition to diagnosing and managing acute, episodic and chronic illnesses.’

In its 2009 census, the American Academy of Physician Assistants’ indicates that the majority of more than 72,000 US physician assistants practice in hospitals (38 percent) or physician groups (35 percent).  While only about 15 percent of PAs work in rural areas, approximately 36 percent practice in primary care.

The Academy’s description of physician assistants’ scope of practice echoes the AANP’s for nurse practitioners. It includes conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, counseling on preventive care, and prescribing medications—along with assisting in surgery for the three percent in general surgical practice and the 22 percent in surgical subspecialties.

Obviously for purposes of this discussion, the main benefit of depending more heavily on physician extenders is improving patient access to primary healthcare services.

Hiring Trends
On the heels of federal healthcare reform’s passage in early 2010, nurse practitioners and physician assistants enjoyed heightened national visibility, according to Advance for NPs and PAs online:

• CNNMoney.com ranked “physician assistant” as the second- best job in America.
• President Obama signed the first presidential proclamation recognizing Physician Assistant Week.
• Nurse practitioner leaders met at the White House several times to discuss healthcare reform.
• The Institute of Medicine's report on the future of nursing called for making independent practice among NPs a national standard.

Still, many hospitals and other healthcare organizations reacted to lower 2010 collections and the specter of federal healthcare reform implementation by trimming staff, rather than making permanent hires.  Thus, many NPs and PAs—especially new graduates—reported having a difficult time finding full-time jobs last year.

Meanwhile, many who were willing to work on a locum tenens basis experienced success as wary healthcare executives turned to temporary hires to meet patient demand. As one industry observer noted, the locum tenens option gives both the healthcare organization and the practitioner a chance to “try before they buy” each other on a full-time basis.

As more physicians choose this option in the face of continuing Medicare reimbursement cuts, high medical liability insurance costs, and growing government involvement in the business of healthcare, there will likely be even greater opportunity—both permanent and locum tenens—for physician extenders to deliver the care needed by millions of Americans.

Tim Hand is the Chief Executive Officer of Interim Physicians and is a healthcare staffing thought leader. Hand has led three companies to inc. 500 status over nearly 30 years.