Perspectives on the Acute Care Continuum
The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
Can PAs and NPs Help With the Physician Shortage?
The number of PAs in the United States is rapidly rising. According to the National Commission on Certification of Physician Assistants, the number of certified Physician Assistants has increased 75 percent in the past eight years from 48,000 to 84,000. In addition, the Bureau of Labor Statistics reports that the employment of physician assistants is expected to increase 30 percent between the years 2010 and 2020. Considering the increasing physician shortage, the 35% increase of the ED patient population over the past 12 years, and the potential that this increase could potentially double in some locations over the next decade, I wonder if in the future PAs could help fill the need in the Acute Care Continuum that Dr. Curry described?
PAs as well as Nurse Practitioners can play a key role within the physician led team. PAs and NPs work in EDs on the front line in Provider in Triage (PIT) programs, in the Fast Track areas, in the Main EDs, as well as in roles caring for acutely ill and injured patients and in our ambulatory and urgent care centers. Hospitalist groups also utilize PAs and NPs in the inpatient hospital setting. PAs and NPs are truly involved in all aspects of patient care that make up the Acute Care Continuum.
A more efficient delivery system could potentially offset the shortage of doctors. When considering the full capacity of a PA or NP, and the many procedures that they can perform, the integration of PAs and NPs does create the opportunity to increase efficiency and cost savings across the Acute Care Continuum. Recently, I have noticed a growing trend to integrate PAs and NPs to their maximum use. For example, the Center for Medicare and Medicaid Services (CMS) has expanded the definition of medical staff to include advanced practice nurses, physician assistants and pharmacists. CMS said that their goal was to enable hospitals to explore new approaches to care by increasing the types of practitioners granted hospital privileges.
I agree with Dr. Weeker when he writes that PAs and NP’s will be a vital part of the future team in the ED. I foresee that the need for PAs and NPs across the Acute Care Continuum will keep increasing, and that the availability of this group of professionals will help us cope with the unknowns of health care reform.
Even more, PAs and NPs not only provide excellent medical care directly to patients but also act as patient advocates and support the physician’s role and responsibilities in patient care. We have a long history of being able to bend and flex as needed and are ready to step up to the challenges with our physician colleagues.