Modern Medical Practice

A relatively unknown public health crisis is looming in the United States. As the U. S. population added 22.7 million people between 2010 and 2020, a large portion of the baby boomer physician generation retired and were not replaced at the same pace by generations X, Y, and Z. By 2034, experts anticipate that the U.S. will be short at least 30,000, if not more than 100,000, physicians.

Evolving Healthcare Landscape

As far back as the 1960s, healthcare professionals began a rethinking of health care delivery in the United States. The physician assistant (PA), the nurse midwife (CNM), and the nurse practitioner (NP) all emerged from that rethinking. The PA, CNM, and NP were the product of demand for greater health care access, especially for the nation's poorer citizens.

The Nurse Practitioner

In a move toward what was termed “role expansion,” with the goal of increasing the primary care workforce the nation's first NP education program was established at the University of Colorado in 1965. From then on, the NP profession and its dedication to elevating nursing clinicians proliferated, and by 1973 the United States offered more than 65 NP programs (AANP, 2019). In that same year, the National Association of Pediatric Nurse Practitioners was established and became the first NP society and only professional organization dedicated to serving the needs of pediatric-focused advanced practice registered nurses (APRNs) and their patients. Over time, advanced NPs expanded into practice settings such as women's health and adult acute care.

The Physician's Assistant (PA)

The founders of these three new health professions worked through existing medical education programs and federal health care initiatives. Their efforts at first received support from private philanthropy, but then, in 1969, the American Medical Association (AMA) rather unexpectedly gave its official approval to the concept of the PA. As optimistic as the originators of the PA movement were, even they did not anticipate the critical role PAs would play in health care delivery well into the new century. With the rising prevalence of chronic conditions like diabetes, hypertension, and asthma, PAs play a vital role in managing these conditions.

• They work with patients to develop care plans, monitor progress, and adjust treatments as needed.
• They spend time counseling patients on managing their health conditions, understanding medications, and making informed decisions about their care.
• They collaborate with other members of the healthcare team, including physicians, pharmacists, and social workers, to ensure seamless transitions and continuity of care.
• They educate patients about their health conditions, address concerns, and empower them to actively participate in their care decisions.

Primary Care

One of the primary roles of NPs and PAs is providing primary care services. This includes conducting comprehensive physical assessments, diagnosing common acute and chronic illnesses, ordering diagnostic tests and interpreting results, and developing personalized treatment plans. They assist in diagnosing and treating a wide range of medical conditions, from minor injuries to complex diseases. They educate patients about preventive measures such as vaccinations, healthy lifestyle choices, and screenings for early detection of diseases.

Quality of Care

Naturally, from the beginning of the NP movement and as the profession advanced, skeptics questioned the quality of care provided by the new advanced practice nurses graduating from the growing number of NP educational programs. In 1994, Mary O'Neil Mundinger, founder of the first clinical nursing doctorate in the country and current dean emerita at the Columbia School of Nursing wrote an article that explored the implications of early-1990s legislative decisions that allowed NPs to receive direct payment and prescribe medication. Mundinger emphasized the strengths of NPs, including the level of expertise and experience they bring to patient-centered care and was a strong proponent of advanced practice providers’ ability to make primary care decisions “indistinguishable from their physician counterparts” (Mundinger, 1994, p. 212).

The New Healthcare Landscape

• By leveraging their complementary skills and expertise, NPs and PAs enhance the efficiency and effectiveness of healthcare delivery. Together, they form a cohesive team that addresses the diverse needs of patients across the lifespan and across various healthcare settings.
• As the healthcare landscape continues to evolve, the contributions of nurse practitioners and physician assistants will remain integral to ensuring that patients receive the comprehensive, compassionate care they deserve.