Medicare for All (M4A) is addressed frequently by politicians and there is growing support for universal health care. Several Democratic candidates favor this policy. Surely, implementation will be difficult but it appears likely over the next 10 – 20 years. This will assuredly be good for patients.
My question is then, how can this, and other points brought forward (below), affect scope of practice (SOP) for current and future physicians?
In my mind, the immediate ramification will be an increase in SOP for NPs and PAs. The number of graduating PAs has risen dramatically over the past several years and there is imprecise data about future numbers. There were 118,000 PAs in 2018 with > 150,000 PAs predicted in the year 2028. I am going to venture to guess this number will be larger than expected. In 2010, there were 74,000 PAs in practice with estimates of 111,000 in 2020 and 127,000 in 2025. Similarly, in 2018 NPs numbered 189,000 with ~ 224,000 predicted for 2028. This greatly exceeds previous estimates. There are nearly 30,000 NPs trained each year. About 3/4 NPs work in primary care. I was not able to find good numbers for PAs practice breakdown. Looking just at NPs, there are more than 22,000 primary care NPs being trained each year.
For context, there were 32,194 PGY1 spots available in the 2019 Match. There are slightly more than 4,100 FM doctors trained each year. Last year, there were 5x more mid-level primary care providers being trained each year than physicians. This is a dramatic shift from a decade ago.
Certainly, there is an ENORMOUS influx of mid-level providers, often serving roles in primary care. The President's recent executive order stated a desire to get rid of supervision and provide payment equity. I do not know how this will play out during the Trump administration. There is clearly support on both sides of the aisle to reduce unnecessary health care spending. It seems obvious, looking at this problem from an economic standpoint, that there will soon be a massive surplus of mid-level and physician primary care providers.
My question for the forum: What advice do you give to medical students interested in primary care? How can primary care-destined medical students diversify their skills?
Thank you for your time and discussion.
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