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Guest commentary: Nurse practitioners keep population healthy

The primary care workforce is changing rapidly. Nurse practitioners are working to keep patients healthy, and more people than ever in Berks County receive primary care services from NPs.

The growth of NPs is good news because it is an opportunity to improve access to care for everyone, including chronically underserved patients. NPs are more likely than physicians to provide primary care to patients who need it the most: seniors, low-income families and those living in rural communities.

Primary care providers like NPs are paramount in an emergency like the COVID-19 pandemic. They serve at the front line, helping patients individually and aiding in broader public health efforts to track and stop the spread. 

 

At the same time, it is a wakeup call to policymakers: Pennsylvania should fully leverage NPs and enable them to practice to the full scope of their education and national certification. Unfortunately, despite the proven benefits of NP practice, the state restricts qualified nurse practitioners with outdated regulations. 

In 2015, the Joint State Government Commission issued a serious warning: Pennsylvania faced a looming shortage of primary care physicians, or PCPs. The report called for an additional 1,039 PCPs by 2030 -- an 11% increase -- to maintain the status quo in regard to primary care access. The shortage and a sharpening rural/suburban divide threatened patients, especially Pennsylvania’s growing number of seniors. 

Despite the warning, the downward trend continued. In a new report, the Pennsylvania Coalition of Nurse Practitioners analyzed data in order to determine the current status of the shortage. We reviewed county-level data from the federal Health Resources and Services Administration for 2015, 2016 and 2017.

Our findings were concerning. Overall, Pennsylvania lost 112 PCPs, down 1% from the 2015 total. The problem is widespread: 37 of Pennsylvania’s 67 counties saw their PCP workforce shrink, including 20 counties with a significant decrease. Another eight counties experienced no increase. 

Despite the advantages of steady population growth, Berks suffered a 10% decrease in its primary care physician workforce. A net 31 PCPs left practice here from 2015 to 2017. Neighboring Schuylkill County stayed flat.

 

Fortunately for patients, the contraction of physician care coincided with an expansion of NP care. The NP workforce grew by a total of 1,613, or 22%. NP care expanded in 57 of 67 Pennsylvania counties; the growth was significant in all of them including 20% increase or higher in 42 counties. The remaining 10 counties saw no change. No county saw a decrease in NPs.

Patients in Berks enjoyed a significant increase. Thirty new NPs came to practice here, an increase of 19%. Schuylkill County patients benefited from a whopping 38% increase in NP care. 

State numbers show that access to NP care is even greater than the federal data. Pennsylvania has 15,391 licensed nurse practitioners in 2020 according to the State Board of Nursing. 

Primary care is the foundation of successful health care. For families, it improves health outcomes and quality of life. For policymakers, it increases efficiency and lowers overall costs. The logic is simple: better access to quality care allows patients to manage small problems before they become big ones. 

State law works against patients and nurse practitioners by adding extra steps beyond the extensive requirements of NP education and national certification. These redundant steps create an obstacle to NP practice. The result of the status quo is reduced access for rural communities, reduced access for low-income patients, and ultimately, sicker patients. 

Almost every major health care stakeholder group in Pennsylvania has endorsed legislation -- Senate Bill 25 and House Bill 100 -- to permanently eliminate these unnecessary steps and adopt a modern process for NP licensure called Full Practice Authority. So far 22 states have adopted this reform; their health care quality improved, access increased and costs decreased.

Policymakers should embrace the growth of the NP profession as an opportunity to improve care for everyone. Pennsylvania patients deserve to benefit from this proven success.

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