We spoke the other day (OK, I’m sure some of you consider that too many other days) about COVID-19 and the vaccine situation. But, there’s another trend that resulted from this pandemic- the use of telehealth, a practice I have been advocating for decades. This is often the preferred modality for patient-healthcare professional interactions, nowadays.
But, that’s building on other trends in healthcare.
About four decades ago, one of my employees requested a recommendation to leave our employ and for her to go to school to become a PA. A physicians assistant. One hardly heard about these professionals back then. But, now- they are fairly ubiquitous. There are some 400 accredited programs across the USA. The list below is just for those in CA, DC, NY, MD, and VA.
Nurse practitioners and PA’s are more equivalent to those obtaining an engineer’s degree. (These degrees are considered to be somewhere between a Master’s and the PhD level.) Like the PA’s (who already have Bachelor’s degrees), NP’s start out as Registered Nurses (which means they already have earned their bachelors). Then the NP program is typically two years of study, allowing them to become accredited nurse practitioners. There are both online and in person educational programs for the NP designation.
My physician has a slew of NP’s and PA’s on his staff. Both of these Advanced Practice Providers (APP’s) are licensed in all 50 states- and now, they can even prescribe medications in the states. (The estimates are they currently write some 1 BILLION scrips a year.) Officially these APP’s come under the rubric of a licensed physician, but many of them head up clinics in rural and out-of-the-way areas. That head of medical practice has increased even more so during the pandemic.
Part of the reason for expanded PA and NP practices is we are expecting a fairly severe physician shortage in the near future. Somewhere on the order of 40K to 90K fewer physicians than we need will be working in 2025. So, the projections of 30% more PA’s and 45% more NP’s by 2029 may not even cover that physician shortage.
Even without the physician shortage, healthcare is relying on NPs and PAs because the physician is simply too busy right now. And, the docs are passing along the telehealth to the PA’s and NP’s, affording the PAA’s the ability to “see” plenty of patients during the day. And, given the COVID pandemic, the public has readily accepted this practice. (You know, the fear of coming face to face with someone who routinely sees and treats the sick.)
Drug firms are taking note of these trends. While many docs simply lack the time to schmooze with those assigned to detail, with the number of prescriptions written by these APP’s , the drug firms realize they need to alert these new professionals about the risks, benefits, and alternatives to the medications they sell.
It IS a brave new world out here.
One of our daughters is an NP in Wisconsin. She really enjoys her work but tells us it can be very tiring and stressful at times. Here in Mexico, I am lucky enough to have a family doctor that has become a friend and has visited the casa when needed. Her approach is holistic before using heavy-duty meds which is why I connected with her years ago. There are a lot of NP’s here that set up an office in a side room of the many “drug-stores” but I do not feel safe visiting them because they can write scripts for anything and I am not sure if they are up to date on the side effects of mixing different drugs. It is not as tightly regulated as it is in the states
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Yes, there is a problem in those areas that lack adequate regulation. Glad you have proper healthcare, Chef William.
Thank you for sharing, a few of my friends are NP or PAs they love their job:)
That’s great. We’d love to hear from them about their experiences.
We give good compassionate care! I was a NP for many years, now a bedside RN.
Thank you for being an NP!
Good info!
Thanks so much. Please come back often.
I have seen them, too, sometimes, instead of doctors. And I wondered what their education levels were. The ones I have seen don’t seem to know any more about chronic fatigue syndrome than the doctors do, unfortunately, but that’s about to change now that so many people will get it as a result of the pandemic. I just hope it doesn’t cripple the work force at the same time we have this huge reduction in available medical staff you are predicting. Everyone could be sick with no one to help them.
If there is a malady that is not well studied, then none of our health professionals will be of much use, unless they’ve decided to study it on their own, Jeanine.
I’ve gone to a physician’s assistant as my primary care medical professional for over 20 years, and a nurse practioner for my gyn for about the same amount of time. I have found both PAs and NPs spend more time with you and they know when a doctor must be involved (like when I needed an invasive diagnostic procedure, the doctor did it). I’m happy that Medicare finally covers telehealth because they didn’t prior to COVID. My last checkup was a telehealth appointment. I hope Medicare will continue to pay for telehealth visits after the COVID pandemic is over.
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Thanks for adding to the discussion, Alana- with your personal interactions with APP’s. Appreciate that!
It is dangerous to allow the permission for prescribing drugs to people with little knowledge or risks,adverse reaction,how to prevent and what to do.While the shortage is real everywhere, no one wants to know why physicians are in short supply or dwindling in number everyday.
Now that is the traditional physician response, Dr. A. Are you claiming that during medical school training, physicians learn about pharmaceutical interventions? We both know that is not true. Much of that knowledge is obtained during the first year of residency and thereafter. The APP’s get training in their programs- and also learn during their required 1 year residency with physicians and hospitals around the globe.