PAs and the future of health care in the United States

In 2010, I chaired the Robert Wood Johnson Foundation's Initiative on the Future of Nursing at the Institute of Medicine (IOM). Our task was to develop a report that would serve as a blueprint for how the nursing profession could be transformed into a more potent force for lasting solutions to enhance the quality and value of US health care and to meet the needs of diverse populations. We envisioned a health care system that promotes health, prevents illness, and cares for people in all settings across the lifespan. We realized that like nurses, PAs have great potential to address many of the challenges we face, including a shortage of primary care providers, an aging and sicker population, fragmentation, and skyrocketing costs. We also realized that advancing interprofessional collaboration would help to ensure coordinated and improved patient care. 


Given these challenges, PAs must play an instrumental 
role in the future health care system. While the numbers of PAs and NPs are steadily increasing, the numbers of medical students and residents entering primary care have declined 
in recent years.¹ With an additional 32 million Americans set to gain health insurance in 2014 under the Affordable Care Act, we need to make sure that there are enough providers 
to serve patients. PAs can play an instrumental role by counseling patients on preventive health, conducting physical exams, and diagnosing and treating illnesses. The growing use of PAs and NPs has helped to ease access bottlenecks, reduce waiting times, increase patient satisfaction, and free physicians to handle more complex cases.² These clinicians also practice in rural areas and at community health centers, where fewer physicians practice. For example, a 2006 survey of all 846 federally funded community health centers found that 46% of direct care providers in rural community health centers were nonphysician clinicians.³


Our committee strongly believed that nurses should be able to practice to the full extent of their education and training. I believe the same holds true for PAs. Current reimbursement policies that prevent PAs from providing hospice care and ordering home health services for Medicare patients need to be overturned. It makes little sense that PAs can conduct physical exams and diagnose and treat illnesses in their offices, but as soon as their patients require hospice or home health care, PAs can no longer care for them. Our committee also felt that we need to improve data collection and analysis across all health professions that provide primary care to truly assess where workforce shortages lie and make the most of scarce resources. 


In addition, we believed it was crucial to foster interprofessional collaboration and team-based care to ensure that our health care system provides patient-centered care and delivers integrated, equitable, cost-effective services. For more than 30 years, studies have demonstrated how the quality and safety of patient care can be improved by effective coordination and communication among health professionals. Working together as integrated teams, health professionals draw on individual and collective skills and experience across disciplines. These teams seek input from and respect the contributions of everyone involved, allowing each provider to practice at a higher level. The result is better patient care. 


In our IOM report, The Future of Nursing: Leading Change, Advancing Health, we called for health professionals to be educated together as students and during their careers through lifelong learning opportunities. This exposure and collaboration early in education and continuing through postgraduate training can provide the foundation that is so critical to improved health care—and the culture among health providers. Members of each profession will be more prepared to deliver interprofessional, team-based care, which requires flexibility in roles and leadership regardless of title. 


Following the release of our report in October 2010, the Robert Wood Johnson Foundation and AARP embarked on a Campaign for Action that builds on the report's recommendations and envisions a nation where all Americans have access to high-quality, patient-centered health care. The Campaign is seeking the support and engagement of a wide range of health care providers, including PAs, consumer advocates, policy makers, and the business, academic, and philanthropic communities. It truly will take all of us to transform our health care system and improve patient care. I encourage PAs to sign up and get involved by going to www.thefutureofnursing.org.


I hope that the health care system our committee envisioned will one day be reality and that all patients will receive high-quality, patient-centered care when and where they need it. I know, without a doubt, that PAs will be central to achieving this vision. JAAPA

REFERENCES


1. Naylor MD, Kurtzman ET. The role of nurse practitioners in reinventing primary care. Health Aff (Millwood). 2010;29(5):893-899.


2. Cunningham R. Tapping the potential of the health care workforce: scope of practice and payment policies for advanced practice nurses and physician assistants. Background paper no. 76. Washington, DC: National Health Policy Forum; July 6, 2010. 


3. Rosenblatt RA, Andrilla CH, Curtin T, Hart LG. Shortages of medical personnel at community health centers: implications for planned expansion. JAMA. 2006;295(9):1042-1049.