Evolving medicine: an analysis of the roles of Physician Assistants and Nurse Practitioners in our current healthcare system

The Physician Assistant and Nurse Practitioner professions initially began in response to healthcare shortages after the Vietnam War in the 1960s. Highly trained combat medical personnel developed into highly skilled PAs, while during this same time nurses began advanced practices that ultimately evolved into the position of NPs. Since this time, the roles and responsibilities delegated to each of these fields have drastically evolved, and are expected to continue to do so in the face of current health care reform under President Obama's Patient Protection and Affordable Care Act initiated in 2010. Originally perceived as "understudies" to physicians, PAs and NPs have become much more trained in their expertise, respected in their roles, and autonomous in their practice. Due to this, it has been predicted that PAs and NPs will become the major primary care providers in the face of increasing demands in this area of medicine. Large numbers of aging populations and up to 32 million newly insured patients seeking healthcare, coupled with physician shortages, have increased demands on PAs and NPs to fill these employment gaps. As there has been an increased demand on the PA and NP profession, there has been a paralleled increase in the number of educational programs producing graduates, larger class sizes, and larger numbers of PAs and NPs entering the workforce. The problem is posed when PAs and NPs, who desire to pay off student loans quickly and, understandably, seek high wages and professional advancement, pursue specialty and subspecialty employment versus filling in primary care gaps as anticipated. As the roles of PAs and NPs change, and more is expected of them in terms of practice and reliability, there are barriers to their growth. Professional tensions between these providers and physicians, poor understanding of what roles PAs and NPs hold by the public, unequal reimbursement for comparable services, and strict state legislation that limits the scope of practice of both PAs and NPs all inhibit these healthcare professionals from practicing to their fullest potential. This, in turn, may hinder persons becoming PAs and NPs from funneling into the ever increasingly demanding primary care field of medicine, and may pose future problems as patient populations increase under the Affordable Care Act. This paper assesses the current roles and responsibilities of PAs and NPs, how each profession is expected to grow, and the evolution of these healthcare providers as the potential "solution" to primary care needs. Statistics regarding current distributions of PAs and NPs in practice, educational expansion, obstacles that these professions must overcome, and the capabilities of PAs and NPs alike are analyzed, and conclusions drawn on what the contributions of these healthcare professionals may be in the future. Overall, it is expected that PA and NP presence in the medical field will undoubtedly increase. Whether these professionals will serve as an adequate source of primary care providers in the face of increasing demands imposed by the Affordable Care Act is yet to be seen, however. Barriers including professional tensions, reimbursement policies, wages, and strict state restrictions on the scope of practice of these individuals will need to be addressed. While it is projected that PAs and NPs will "solve" the current and future primary care physician shortage, this fact truly remains to be seen