‘The nurse practitioner will see you now:’ Local patients being seen by increased number of non-physicians

“At the time, it was either starting down a management administrative path or taking this next step into advanced practice,” said Stahl, who is a family nurse practitioner who practices with the Kettering Health Medical Group Primary Care in Springboro.

Advanced practice providers are trained and licensed to provide medical services, such as diagnosing and providing treatment, prescribing medication and performing physical exams. The providers also work in a variety of health care settings, including outpatient and inpatient settings, physicians’ offices, hospitals and/or clinics.

“The more I thought about it, prayed about it, all of those things, it really just seemed like the next natural step into this part of my career as a practitioner,” she said.

The U.S. will face a physician shortage of up to 86,000 physicians by 2036, according to the most recent projections from the Association of American Medical Colleges.

A team-based approach

While advanced practice providers like nurse practitioners and physician assistants don’t go through the level of training that physicians go through, the state of Ohio requires advanced practice providers to work in collaboration with a physician. Collaborating physicians can work with multiple practitioners while they provide additional oversight and input.

“Realistically, our roles look almost exactly like a physician,” Sara Wilson-Rector, a family nurse practitioner with Premier Health, said about nurse practitioners in the area of primary care.

Wilson-Rector also advises new advanced practice providers through the Premier Health Primary Care Residency, which is a three-month onboarding program for the new providers.

There are few things that nurse practitioners like Wilson-Rector can’t do, such as order a patient’s diabetic shoes or sign a death certificate. She can still treat the diabetes itself, though, evaluating the patient and prescribing the insulin.

A collaborating physician for nurse practitioners does not have to be on site when the nurse practitioners are seeing patients, Wilson-Rector said.

“You just have to have access to your collaborative (physician),” she said.

A shortage of primary care providers

Areas of health care like primary care or family medicine are already experiencing the impact of this shortage as fewer physicians are going into primary care. At the same time, the U.S. population is increasing and growing older as people continue to live longer.

“We feel this a lot in primary care. Some of the specialties, maybe not as much, but we definitely feel this in the primary care because we have a lot more insured. We have a lot older, aging population that need care and access to care, and when we need access, we have to look outside the box sometimes,” Stahl said.

The two largest health systems in the area, Kettering Health and Premier Health, have both looked to advanced practice providers to step into open health provider roles, following a national trend of more patients getting seen by non-physicians.

Credit: Jim Noelker

Credit: Jim Noelker

Nurse practitioners and physician assistants now account for a quarter of health care visits, researchers say. Between 2013-2019, health care visits delivered by nurse practitioners and physician assistants in a year increased from 14.0% to 25.6%, according to an analysis from Harvard Medical School researchers in the general medical journal the BMJ.

Among all patients with at least one visit in 2019, 41.9% had one or more nurse practitioner or physician assistant visits, those same researchers found.

Local providers find their niche

For Micayah Mills, pursuing a career as a physician assistant gave her more time to decide on a specialty.

“I knew after undergrad that I wanted to do something in health care but I wasn’t exactly sure what,” said Mills, who is a physician assistant in neurosurgery with Kettering Health. “One of the cool things about this profession is that you don’t have to know what specialty you want to go into initially.”

While studying to become a physician assistant, Mills found what she was most interested in through the clinical rotations she had, she said.

Sarah McPherson, a nurse practitioner in medical oncology at Kettering Health, started her career as a nurse, she said.

“With my nursing background, I wanted to be able to evaluate, diagnose and treat patients more independently while still working as part of the medical team as a whole,” McPherson said.

McPherson also gets to continue practicing in a holistic approach, including utilizing the interpersonal skills she learned from the bedside.

They can work independently, she said, helping improve access to care in areas where it may be limited.

“APPs help a lot with that burden,” McPherson said. “I don’t know if you’ve called your doctor to try to get in and sometimes it can be months down the road. A lot of times having APPs allows easier access.”

A report by Medical Care, a peer-reviewed journal from the American Public Health Associations looked at nearly 24,000 patient visits over five years, looking at nine different patient outcomes and quality measures among physician assistants, nurse practitioners and primary care physicians.

The 2017 report found there was no statistical difference in seven out of the nine outcomes regardless of a patient’s provider.

By the numbers