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See Inside March 2011

A Little Help from Their Friends

As more Americans sign up for health care, they'll be more likely to see nurses and physician assistants instead of doctors. That's a good thing



David Muir Getty Images

Physician Assistants
Number in 2008: 74,800
Growth rate from 2004 to 2009: 29%
Average years of education: 18

Nurse Practitioners
Number in 2008: 158,348
Growth rate from 2004 to 2009: 39%
Average years of education: 18

Registered Nurses
Number in 2008: 2,618,700
Growth rate from 2004 to 2009: 12%
Average years of education: 15

As health care reform rolls out over the next five years and millions of newly insured seek treatment, the shortage of general medicine doctors will only worsen. Many researchers anticipate that physician assistants (PAs) and nurse practitioners will step in to fill that gap. They are already on the front lines, handling more and more routine visits, and their numbers are expected to increase in the coming years. Researchers are finding that the presence of PAs and nurse practitioners at doctors’ offices may help improve both the quality and availability of medical care.

Today community health care clinics are twice as likely as private practices to employ PAs and nurse practitioners. Thanks in part to the PAs and nurses, one recent study published in the Journal of Community Health found, clinics were able to see a greater volume of patients and to remain open for longer hours. The clinics were also able to spend more time educating patients about their conditions—something that nurses and PAs were more likely to do than doctors. Clinics also employed an efficient division of labor, whereby PAs were deployed more to patients with acute conditions such as colds or minor injuries, and doctors treated more patients with chronic conditions. Right now who one sees at the doctor’s office is too often dictated by scheduling convenience, rather than by how tricky one’s case is, says Roderick Hooker, a health services researcher at the Lewin Group in Falls Church, Va., and co-author of the paper. As more PAs and nurses join private practices, community health clinics could be used as a model. With the flood of new patients, doctors will need all the help they can get.

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