Health care careers in the 21st century can no longer be defined by just the traditional roles of doctors and nurses. Advanced practice providers, such as nurse practitioners and physician assistants, are becoming a key part of the equation.
The medical workforce is seeing a rise in midlevel, or advanced practice, providers, working across the spectrum of health care to meet the demands of a growing and aging population.
The number of physicians in the U.S. grew from 737,764 in 1996 to 954,224 in 2008, a 29 percent increase, according to a 2011 American Medical Association report. But the number of physician assistants went from 29,161 to 73,893 and the number of nurse practitioners from 70,993 to 158,348 in the same period. That’s an increase of 153 percent and 123 percent, respectively.
Advanced practice providers are a growing part of many private practice, hospital and clinic health care teams, prized for their quality care and lower cost. Physician assistant ranked second on the Money/CNN Best Jobs in America list for 2010 and 2011, yet like many kids, Caroline A. Howell never heard of the role growing up.
“My mom was a nurse, and I fell in love with her anatomy books as a child. I was going to be a doctor and took pre-med in college, but as I began studying for the MCAT [medical college admission test], I wasn’t sure being a doctor was right for me,” said Howell, a physician assistant with Georgia Skin Specialists, in Atlanta.
Her mom knew a physician assistant in an oncology office who let Howell shadow her. Afterward, she applied to the physician assistant program at Emory University and has been a certified physician assistant in dermatology for 12 years.
“I don’t have to explain who I am and what I do to patients as much these days. When they meet you and see what you can do, they come back,” said Howell. Licensed to practice medicine under the supervision of a physician, she sees patients, diagnoses illnesses, prescribes medication and performs cosmetic and medical procedures. She also lectures in the PA program at Emory.
“The bottom line is that I always wanted to focus on medicine and help patients, and that’s exactly what I get to do. This career is a perfect fit,” she said.
Forty-nine percent of physicians employ physician assistants, nurse practitioners or certified nurse midwives in their offices, according to the AMA report, but hospitals now welcome their services, too.
“The master’s prepared nurse practitioner role was created [more than 40 years ago] to provide primary care due to a shortage of general practitioners. In the last 10 years, more are working in acute care, as adjuncts to medical specialists. The role is expanding,” said Joyce Ramsey Coleman, chief nurse executive at Children’s Healthcare of Atlanta. The hospital uses almost 300 advanced practice providers in a variety of specialties. Some are employed by the system and others by doctors’ who practice at CHOA.
“Advanced practice providers give our patients greater access to health care, because our physicians would never have time to see everyone,” said Ramsey Coleman. Research has shown that they give safe and effective care. “The Institute of Medicine 2010 report on the Future of Nursing’s first recommendation was to remove the scope of practice barriers of these providers and maximize their roles in health care.”
Linda Ballard became a nurse practitioner in 1995, looking for more autonomy and opportunity in her nursing practice. She’s now lead pediatric nurse practitioner in the Aflac Cancer Center and Blood Disorders Service at CHOA. She works collaboratively with physicians to manage the care of hematology and oncology patients.
Kim Woodall loved working in critical care but wanted to be able to provide more autonomous care and education to her patients and their families. She became a nurse practitioner in 2001. Today, she’s the program manager for advanced practice providers in cardiac services at CHOA.
“Technology has increased the life span and acuity of patients, and there aren’t enough specialty physicians. With health care moving towards no less quality, but more cost-effective care, the greater use of advanced practice providers is a no-brainer,” said Woodall.
For two years, she and Ballard have been developing an Advanced Practice Council at CHOA.
“With the numbers growing, we wanted to support these providers and their unique practice and licensure issues and to make leadership more aware of their capabilities,” said Ballard.
Ballard has seen advanced practitioners grow as leaders and partners on health care teams to make an impact on patient care. “They have great career opportunities ahead. That’s positive for the role and for health care,” she said.
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