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Special Communication |

Current and Projected Workforce of Nonphysician Clinicians

Richard A. Cooper, MD; Prakash Laud, PhD; Craig L. Dietrich, BS
JAMA. 1998;280(9):788-794. doi:10.1001/jama.280.9.788.
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Nonphysician clinicians (NPCs) are becoming increasingly prominent as health care providers. This study examines 10 such disciplines: nurse practitioners (NPs), physician assistants (PAs), nurse-midwives, chiropractors, acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists, and clinical nurse specialists. The aggregate number of NPCs graduating annually in these 10 disciplines doubled between 1992 and 1997, and a further increment of 20% is projected for 2001. Assuming that enrollments remain at the levels attained in 2001, NPC supply will grow from 228000 in 1995 to 384000 in 2005, and it will continue to expand at a similar rate thereafter. The greatest growth is projected among those NPCs who provide primary care services. Moreover, the greatest concentrations of both practicing NPCs and NPC training programs are in those states that already have the greatest abundance of physicians. On a per capita basis, the projected growth in NPC supply between 1995 and 2005 will be double that of physicians. Because of the existing training pipeline, it is probable that most of the growth projected for 2005 will occur. The further expansion of both NPC and physician supply thereafter warrants careful reconsideration.

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Graphic Jump Location
Figure 1.—Supply of traditional and alternative nonphysician clinicians, 1990 to 2015. Data include the actual numbers of active clinicians in 1990 and 1995 and the projected supply in 2005 and 2015. Others include numbers of actively licensed practitioners.
Graphic Jump Location
Figure 2.—Supply of alternative nonphysician clinicians, 1990 to 2015. Data include the actual numbers of active clinicians in 1990 and 1995 and their projected supply in 2005 and 2015.
Graphic Jump Location
Figure 3.—Supply of specialty nonphysician clinicians, 1990 to 2015. Data include the actual numbers of active clinicians in 1990 and 1995 and the projected supply in 2005 and 2015.
Graphic Jump Location
Figure 4.—State distributions of physicians and nonphysician clinicians per 100000 population. Data are for 1995. Physicians are expressed as resident-adjusted patient care physicians,4,9 excluding psychiatrists. NPs indicates nurse practitioners; PAs, physician assistants; CNMs, certified nurse-midwives; and CRNAs, certified registered nurse anesthetists. Asterisks indicate that licensure is recent; state data are not yet available.
Graphic Jump Location
Figure 5.—Primary care and specialty physicians and primary care and specialty nonphysician clinicians (NPCs) in 1995 and 2005. Primary care physicians include family physicians, general internists, general pediatricians, and obstetrician-gynecologists. Specialty physicians include all other patient care physicians except psychiatrists. Primary care NPCs, include primary care nurse practitioners, primary care physician assistants, certified nurse-midwives, chiropractors, acupuncturists, and naturopaths. Specialty NPCs include specialty nurse practitioners and physician assistants, optometrists, podiatrists, certified registered nurse anesthetists, and medical and surgical clinical nurse specialists. Data for physicians include practicing patient care physicians; residents are excluded. Workforce estimates are expressed as clinicians per 100000 population.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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