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Investing in NPs/PAs to Improve Primary Care Provider Shortages

At the end of February, the Millbank Memorial Fund released their 2024 primary care scorecard entitled ‘No One Can See You Now’. A bleak assessment of primary care in the United States, the scorecard identifies five key contributors to the ever-worsening patient access crisis, the top two of which cite the need for workforce expansion1:

  • Reason 1: The primary care workforce is not growing fast enough to meet the population needs.
  • Reason 2: The number of trainees who enter and stay on the professional pathway to primary care is too low, and too few have community-based training.

In response to this ongoing patient access crisis and with the passage of the 2010 Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has moved toward rewarding quality of care by implementing and endorsing value-based arrangements. Under these models, resources are allocated based on accurately assessed patient risk and clinicians are rewarded based on their meeting certain quality goals (i.e., MIPs, HEDIS, etc.). Success in these areas requires increased documentation and additional patient visits, respectively, begging the question: what can be done to ensure already strapped PCPs and health systems succeed under these arrangements?

In its evaluation, the scorecard highlights a decrease in the national average of physicians practicing in primary care over the last decade – 26.6% in 2021, compared to 27.9% in 2016. In fact, more than half of physicians who begin residency training in primary care, opt to subspecialize or become hospitalists citing burnout due to high levels of administrative burden and inadequate staffing.2 While rates of physician entry and retention in the primary care space are worsening, the gross number of primary care providers has actually increased 19% since 2016, suggesting that Advanced Practice Providers (APPs) – Nurse Practitioners (NPs) and Physician Assistants (PAs) – are entering the equation and that appropriately leveraging this group of providers could be key to beginning to move the needle on patient access.3

And yet, the access gap persists and the demand for workforce support to fulfill the promises of value-based care is still not being met. For many of the same reasons physicians exit outpatient primary care, APPs can be hesitant to enter it. These include increased administrative burden, relative low pay to their counterparts in specialty areas of medicine and increasing complexity within their patient mix. In addition, physician networks that are newer to hiring and employing APPs as part of their primary care workforce, may be unaware of how to maximize their utilization leading to APPs not practicing at top-of-license or burnout due to unfamiliar culture.

If APPs are to succeed at being the quarterbacks of patients’ care and contribute to organizational success under value-based arrangements, they need a show of support and the opportunity to realize and demonstrate their merit in the PCP role; the best way to attract and keep NPs and PAs on the trajectory of primary care post-graduation is to invest in them when they are novice providers through training structured specifically to increase new provider confidence, competency and resilience in practice.

As the number of post-graduate APP residencies and fellowships — and bodies that accredit them — continue to increase, this type of training is being recognized by organizations as the standard to rapidly bring novice APPs into the primary care workforce and prepare them for success under value-based arrangements.

COPE Health Solutions has partnered with organizations across the country, including community health centers (CHCs), to deliver our proved post-graduate training to APPs. This is a solution for organizations looking to establish a culture that embraces APPs, attract high-potential and quality APPs and increase physician understanding of how to maximize APP value on their teams. CHS can work with your physician network to achieve full utilization of APPs, increasing well and preventative care access within physician panels and leveraging team-based care principals to improve provider and patient satisfaction. Contact us at info@copehealthsolutions.com or call us at 213-259-0245 for more details on how we can help your organization add to the primary care workforce and help to alleviate the national deficits in healthcare.



1 (Milbank Memorial Fund, 2024)

2 (National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being, 2019)

3 (Milbank Memorial Fund, 2024)

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