The Rise of the Midlevel Provider

Several recent articles have commented on the shortage of physicians.  In particular, the Atlanta Journal-Constitution reported “The number of physicians in the U.S. grew from 737,764 in 1996 to 954,224 in 2008, a 29 percent increase, according to a 2011 American Medical Association report. But the number of physician assistants went from 29,161 to 73,893 and the number of nurse practitioners from 70,993 to 158,348 in the same period. That’s an increase of 153 percent and 123 percent, respectively.”

The US healthcare system is adjusting to the difficult and expensive problem of training new physicians (MD and DO) by training midlevel providers (nurse practitioners or physician assistants).  The midlevel providers must go to college and then have 2-3 years of additional training as opposed to the additional 7-10 years for physicians.

The midlevel providers are a welcome addition to the health care workforce.  They fit an interesting gap not well filled by physicians.  They provide more face to face time with patients, they provide excellent health care education for patients, they tend to follow evidence based guidelines more closely than physicians and they excell at routine type patient interactions.(see examples below).  Physicians will always have the advantage in diagnosis of illness and complex problem solving due to the nature and duration of their training (some claim this advantage fades as midlevel providers gain  experience in their area of practice over several years)

So, how should patients take advantage of the growing number of midlevel providers?  Seek providers (MD and DO) that are part of organizations that include midlevel providers in a ratio of about 1 – 2 midlevels to 1 MD or DO.  Look for a team approach to patient care where the midlevel providers do a lot of the routine visits but the MD and DO providers are on the front line for acute or new problems.  This type of a setting helps to improve access to care — better access hopefully means longer visits, better education and higher satisfaction.  If a patient calls a primary care provider’s office for an appointment with a new problem it should be with the MD or DO.  In the course of a routine visit if a problem clearly needs a specialist the midlevel should be able to make the referral just like an MD or DO.


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