Specialty practices increasingly rely on nurse practitioners, physician assistants

Doctors talking
The number of NPs and PAs in specialty practices increased by 22% from 2008 to 2016. (Getty/wmiami)

It’s not just primary care practices that are increasingly relying on advanced practice clinicians to help care for patients. A new study found that 28% of all specialty practices are employing nurse practitioners and physician assistants.

The number of NPs and PAs in specialty practices increased by 22% from 2008 to 2016, according to a research letter published in JAMA Internal Medicine.

In comparison, there was an even greater increase of advanced practice clinicians in primary care, which saw a 24% increase over the same time period.


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Multispecialty practices were most likely (49%) to hire NPs and PAs, while surgical specialties were least likely (21%) to employ them, the study found.

The researchers, led by Grant R. Martsolf, Ph.D., of the University of Pittsburgh’s School of Nursing, said the employment of advanced practice clinicians in primary care has been well documented, but less was known about their use in specialty practices.

RELATED: Physician assistants continue to move into specialty areas, including hospital medicine and surgery

Employment of NPs grew at a faster rate (33%) than employment of PAs (20%) between 2008 and 2016.

Not only are more specialty practices employing advanced practice clinicians, a study last year found they are using these providers to provide more than routine follow-up care. In more practices, NPs and PAs are increasingly seeing new patients and those there for acute visits.

Among the top 10 specialties that researchers looked at, advanced practice clinicians were employed in at least 25% of practices in these specialties: cardiology, obstetrics-gynecology, dermatology, gastroenterology and orthopedic surgery.

A report last year from the National Commission on Certification of Physician Assistants found that more than 70% of PAs work in specialties outside of primary care, including in highly technical surgical specialties. PAs working in specialties are also well compensated, earning an average salary of more than $104,000. 

The researchers said value-based care models, incentives for team-based care and the pressure to reduce costs have led to the overall growth in hiring of advanced practice clinicians.

While it may sound like a contradiction, medical groups that hire more nonphysician providers and key support staff can increase revenues, an analysis by the Medical Group Management Association found.

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