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Minnesota is suffering from a primary health care workforce shortage and the road to improved population health begins with increased access to care. A large portion of the primary care workforce is nearing retirement while fewer medical students are choosing primary care as their specialty. These shortages are particularly significant in the rural parts of Minnesota. Clearly there are benefits of Nurse Practitioners (NPs) and Physician Assistants (PAs) to health care organizations, and the Obama administration has championed NPs and PAs as an important part of the answer to our nations' health care problems.
Growth in the number of PAs has grown substantially in the past several years. In March 2012, Minnesota had over 1,700 licensed PAs, over three times the number from 10 years ago. According to Health Guide USA, PA opportunities are expected to increase 30% from 2010-2020 due to increased need. This should be particularly true for PAs working in rural and medically underserved areas, as well as those working in primary care. With more physicians entering non-primary care areas of medicine, there will be a growing need for primary health care providers, including PAs. Additionally, general population growth and an increase in the number of insured citizens, due to health care reform, will further spur opportunities for PAs as more people seek health care.
Physician Assistants are master's degree prepared health care professions licensed to practice medicine under physician supervision. They are trained to examine patients, diagnose injuries and illness and provide treatment. Until recently, there was only one established PA program in Minnesota, belonging to Augsburg College in Minneapolis. In the summer of 2012, St. Catherine University in St. Paul opened their new PA program. These two programs graduate approximately 55 students each year. Bethel College is scheduled to accept their first PA students in the fall of 2013 and the PA program at The College of St. Scholastica is tentatively scheduled to open in 2015. There is also a strong connection with Mayo Clinic Health System, located in southern MN, and the University of Wisconsin-LaCrosse Gunderson Lutheran PA program.
Minnesota currently reports nearly 3,100 licensed Nurse Practitioners. According to the Bureau of Labor Statistics Occupational Outlook Handbook, 2012-2013 Edition, NPs will enjoy a forecast of increasing job opportunity. All four categories of advanced practice nurses (Nurse Practitioners, Nurse Midwives, Clinical Nurse Specialists and Nurse Anesthetists), as well as Registered Nurses, will be in high demand, particularly in underserved populations like rural and inner-city communities.
Nurse Practitioners programs are now offering a Doctorate degree (DNP). Minnesota currently has 7 NP programs throughout the state: St. Catherine University, The College of St. Scholastica, Metropolitan State University, Minnesota State University Mankato, University of Minnesota, Walden University and Winona State University. These programs graduate approximately 135 students annually.
Nurse Practitioners currently serve patients in a wide variety of settings under varying degrees of physician supervision. They can prescribe medication, often function as primary caregivers in many locations and can choose to specialize in whatever aspects of health care interest them most. The most common specialty for NPs is family medicine, followed by adult, women's health, gerontology and pediatrics.
Primary care providers are often a patient's first point of contact in the health care system and increasing the role of NPs in providing primary care services has the potential to help alleviate the primary care workforce shortage. One option for states is to re-examine the scope of practice laws governing NPs. The American Academy of Nurse Practitioners (AANP) is focusing on: improving Medicare regulations to include NPs' patients as beneficiaries in accountable care organizations (ACOs); the ability of NPs to order/certify home health care services for Medicare patients; Title VIII funding for NP education programs; and traineeships and, funding for nurse-managed centers.
While an increase in education capacity and recruitment of providers is part of the workforce shortage solution, retention is equally as important. There are many elements involved as part of a successful retention plan such as orientation, practice feedback and satisfaction surveys, recognition activities and mentor programs to name a few. Some retention factors that are most important health care providers include: availability to relieve coverage; availability of specialists; income potential; help with retiring education loan; compatibility with others in health care, and quality housing and schools.
The National Rural Health Resource Center and the National Rural Recruitment and Retention Network, under contracts from the Indiana State Department of Health, Minnesota Department of Health Office of Rural Health and Primary Care, and the Wisconsin Department of Health Services Division of Public Health, has created the Midwest Retention Toolkit.
Another great retention tool is loan repayment. Minnesota offers three different federal and state programs to NPs and PAs. The Minnesota Rural Midlevel Practitioner Loan Forgiveness Program is offered to midlevel practitioner students, which includes Nurse Practitioners, Certified Nurse Midwives, Nurse Anesthetists, Advanced Clinical Nurse Specialists and Physician Assistants. Through this program, the above providers can receive $6,750 annually for a minimum of three years and a maximum for four years of service in rural Minnesota. The Federal National Health Service Corp Loan Repayment Program offers full-time providers $30,000 annually for a minimum of two years and a maximum of four years of service in a health professional shortage area (HPSA). The Minnesota State Loan Repayment Program provides recipients with $20,000 annually by completing a two-year service obligation in a nonprofit private or public site that is located in a federally designated HPSA.
With more national focus on prevention rather than just treatment, approximately 35 million newly insured individuals, many practicing physicians expected to retire and an aging population, expanded use of NPs and PAs could be critical to the delivery of primary care and the increasing health care demands in this country.
