New research published in the Journal of General Internal Medicine has revealed that physicians, physician assistants and chiropractors tend to practice in more affluent areas with already high life expectancy , while nurse practitioners tend to treat patients in lower income areas with low life expectancy.
The idea for the research came from a long-standing debate among those who study health care workforce issues about the physician shortage problem, according to study author Matthew Davis, assistant professor at the University of Michigan School of Nursing.
Some leading authorities have argued that the answer to the physician shortage is to establish more medical schools and produce more doctors. But other authorities have pushed back on that notion, suggesting that more physicians would just mean fewer primary care physiciansand more medical specialists that some people feel aren’t needed. It’s also been a widely held belief that physicians head to wealthier areas to practice.
Researchers decided to see if that belief held up across counties of different economic means and health status (life expectancy), and discovered that indeed, the areas with the highest income – compared to the lowest – had 30 percent more physicians and 15 percent fewer nurse practitioners. Researchers also studied distribution of chiropractors and physician assistants, which followed the physician trend.
The counties deemed the least healthy had approximately 50 percent more nurse practitioners than the healthiest counties. This may imply that nurse practitioners are playing a role in communities that need their help, according to Davis.
Davis notes the study didn’t look at what drives decisions by nurse practitioners where to practice, but says “there’s a lot of factors that come into play.” There’s been a lot of work to understand where physicians practice and what drives them to do so. It comes down to the providers’ sociodemographic characteristics, where they trained and market forces of where the jobs are.
Applying this logic to nurse practitioners, in theory one would see that they have a different sociodemographic makeup than physicians – i.e., mostly female and non-Hispanic white; that schools nurse practitioners come from may be located in different areas than medical schools; and that available nurse practitioner jobs may just be in these low-income areas. This is all speculative, Davis says.
While both nurse practitioners and physicians tend to work at major health care institutions, nurse practitioners provide a substantial amount of care to community centers and treat patients dealing with chronic illnesses like diabetes and heart disease.
According to Joyce Knestrick, president of the American Association of Nurse Practitioners, the University of Michigan’s findings “reinforce what we’ve seen across the 22 states that have modernized regulations to allow patients direct access to nurse practitioner care.” She says that nurse practitioners will head to where they are needed most.
For its part, the American Medical Association says its own data – along with information from the Centers for Medicare and Medicaid Services – indicate physicians and nurse practitioners tend to practice in the same areas.
The Association of American Medical Colleges anticipates that by 2030, there will be a shortage of between 40,800 and 104,900 primary and specialty care physicians. But the Bureau of Labor Statistics predicts physician assistant and nurse practitioner positions are going to rise – 37 percent and 31 percent, respectively. By comparison, physicians and surgeon employment is predicted to grow by 13 percent.
Researchers are interested in looking more at the different environments in which nurse practitioners work and understanding the effects on quality of care in nurse practitioners working in teams versus independently.