Written by Evangeline Wilds

Over the past decade, the amount of newly-certified physician assistants and nurse practitioners has increased dramatically. Across the U.S., 10,000 physician assistants became certified in 2019 alone. And for nurse practitioners, numbers jumped from 91,000 in 2010 to 190,000 in 2017. The U.S. Bureau of Labor Statistics predicts both professions will continue to grow, ranking them in the top ten fastest-growing jobs between 2018 and 2028.

As more and more new nurse practitioners and physician assistants become certified, many Texas doctors have noted their entries into hospitals, clinics and practices all over the state.

Rob Wiley

“Hendrick Health System has seen an increase in nurse practitioners and physician assistants in almost every specialty across the hospital – especially in our surgical, neonatal intensive care unit, cardiovascular services and hospitalists programs,” said Dr. Rob Wiley, chief medical officer for Hendrick Health System in Abilene. “Within our employed physician groups, we have also seen that number continue to grow.”

While many physician assistants and nurse practitioners pursue careers in outpatient primary care, others find rewarding jobs in inpatient hospital settings. Since they require fewer years of training but can still perform some of the same tasks as doctors, utilizing physician assistants and nurse practitioners on clinical care teams has proven to be a cost-effective way to maximize team efficiency and offer patients the best care possible.

“As valued members of our health care teams, mid-level providers work collaboratively and closely with physicians to provide the highest level of patient care,” Dr. Wiley said. “Nurse practitioners and physician assistants continue to take on bigger roles as true physician extenders, allowing physicians to do more and focus on complex patient cases.”

Meeting Needs in a National Shortage

The wave of newly-certified physician assistants and nurse practitioners is also helping hospitals confront a looming nationwide shortage of physicians. According to a 2019 report by the Association of American Medical Colleges, “The U.S. will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply.” Many hospitals see the solution as increased use of non-physician clinicians, such as physician assistants and nurse practitioners, who are being asked to practice to the fullest extent of their training.

John Kasel

As Director of Advanced Practice Providers for the central region of Baylor Scott & White Health, John Foster Kasel, DHA, PAC has played an integral role in the organization’s relationship to physician assistants and nurse practitioners. Because Baylor Scott & White has seen “a steady increase in our number of providers,” according to Kasel, they hold strategy meetings to discuss the relationship between physician assistants and doctors.

“What we saw was the future,” said Kasel. “Much focus was on the fact that we needed to be practicing at the top of what licenses allow, which was not always the case. There was awareness and recognition that we could be fully utilized, and we wanted to function in teams so that everyone is doing what they’re best at doing. We’re finding that many our physician leaders are training [advanced practice providers] to do things they maybe hadn’t thought of doing before.” This approach may prove to be especially impactful for mental health providers, where there is “a shortage of physician providers and strong demand for services,” Kasel said.

nurse practitioner talking to a patient

Providing Care in a Pandemic

In the wake of the global COVID-19 pandemic, many physician assistants and nurse practitioners are taking on new roles to meet the rising tide of virus patients. In contrast, others have found themselves out of work as plummeting revenue forces hospitals to cut costs. Healthy patients are putting off elective procedures to avoid the hospital, and those in need of emergency care may be going without the treatment they need for fear of the virus.

Though average physician assistant compensation had grown to an average of over $113,000 per year in 2019, the pandemic brought furloughs, job losses and cuts to work hours that have profoundly affected many providers across the country. After conducting a national survey to assess the impact of COVID-19, the American Association of Physician Assistants reported that 22.1% of physician assistants surveyed had been furloughed, 58.7% had seen reductions in work hours, and 3.7% had been terminated. Of those working directly with COVID-19 patients, 31.7% have gone without necessary personal protection equipment. These numbers show the unfortunate reality of a global pandemic: when health care workers are the most needed, there are the least resources available to keep them safe, healthy and employed.

However, for those hospitals able to retain a full staff, technology has become an essential part of daily life, as physician assistants and nurse practitioners have been reassigned to the frontlines of COVID-19 testing and treatment.

Susie Cassle

“Since the beginning of COVID-19, Hendrick has relied heavily on our physician assistants and nurse practitioners,” said Susie Cassle, RN, MSN, chief nursing officer for Hendrick Health System. “Hendrick Health set up a virtual COVID-19 screening and treatment tool for the community and our mid-levels oversaw the screening clinic. They screened patients and provided telehealth visits and patient education, as well as tested individuals for COVID-19.”

At Baylor Scott & White, physician assistants and nurse practitioners are trained to conduct electronic visits and video assessments with patients. Patients diagnosed with COVID-19 are put on a “digital care journey,” which allows staff to monitor patients’ symptoms through digital surveys and provide care and treatment from afar. This practice helps to mitigate the spread of the virus and opens beds for patients in more critical condition. According to Kasel, all of this is only possible through the quick action and innovation of Baylor Scott & White’s leadership team and the flexibility of its advanced practice providers.

Chart, increase in PAs and NPs 2018-2019

“We’ve had some great leadership from the executive team that got task forces focused in the digital health area,” said Kasel. “These groups of bright and talented people came together to create solutions and, more importantly, got things implemented in days instead of months.”

Debating the Future of Health Care

With increasing numbers of newly-certified advanced practice providers entering the workforce and number of doctors decreasing, nurse practitioners and physician assistants may need to step into even more significant roles than they have previously filled.

Some physician assistants believe this will require policy changes through the adoption of “optimal team practice,” which would remove administrative barriers to greater collaboration between physician assistants and doctors. However, some doctors are skeptical, maintaining that physician-led care should not be undervalued as the standard for hospital teams.

Regarding the influx of nurse practitioners, some experts find it worrying that registered nurses are leaving their jobs to pursue higher-paying positions in increasing numbers. This may represent a future shortage of RNs working in hospitals, as many newly-certified nurse practitioners find jobs in primary care outside of hospital settings.

Working as a Team

Despite differences of opinion on how physician assistants and nurse practitioners will fit into the ever-evolving landscape of health care, one fact is undeniable: these providers are becoming more essential to clinical care, as COVID-19 has made abundantly clear.

“These practitioners are invaluable team members,” said Dr. Wiley. “Their responsibilities, which include educating patients, expediting throughput, writing orders and participating in plans of care, help drive more efficient patient care.”