Current and Projected Workforce of Nonphysician Clinicians

Cooper RA, Laud P, Dietrich CL. — Wed, 02 Sep 1998 00:00:00 GMT

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.

Roles of Nonphysician Clinicians as Autonomous Providers of Patient Care

Cooper RA, Henderson T, Dietrich CL. — Wed, 02 Sep 1998 00:00:00 GMT

Studies were undertaken to assess the practice prerogatives of nonphysician clinicians (NPCs) in 10 disciplines that, collectively, are the major nonphysician contributors to the delivery of medical and surgical services. These disciplines include nurse practitioners, physician assistants, nurse-midwives, chiropractors, acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists, and clinical nurse specialists. Marked differences were found in the practice prerogatives that states granted NPCs in the various disciplines. For most disciplines, the magnitude of their prerogatives correlated with the numbers of NPCs practicing in each state. At their maximal levels, state practice prerogatives authorized a high degree of autonomy and a broad range of authority to provide discrete levels of uncomplicated primary and specialty care. The recent growth in these prerogatives is fostering new opportunities for NPCs; however, it also is creating a pluralism that has the potential to further fragment the US health care system. It is time for regulatory integration and professional collaboration so that a health care workforce that includes a diversity of disciplines can be assured of providing a coherent set of patient care services in the future.

JAMA: Nail Diseases Topic Collection

Current and Projected Workforce of Nonphysician Clinicians

Roles of Nonphysician Clinicians as Autonomous Providers of Patient Care