ANN ARBOR, Mich. Pediatric health care work force planning efforts are increasingly incorporating the roles of nurse practitioners and physician assistants, especially in plans to alleviate the perceived shortage of pediatric subspecialists.
However, results from four new studies of pediatric nurse practitioners, family nurse practitioners, neonatal nurse practitioners, and pediatric physician assistants published online today in the journal Pediatrics do not seem to support that idea. The work was conducted by the University of Michigan's Child Health Evaluation and Research (CHEAR) Unit, led by Gary Freed, M.D., M.P.H., chief of the Division of General Pediatrics and director of the CHEAR Unit.
"Although there are overall increases among those professionals, there has been no increase in the number of nurse practitioners and physician assistants going into pediatric health care," Freed says. "Newly trained professionals in those jobs will likely decrease going forward as more health care systems are designed to take care of the elderly population. Health systems need to re-think many of their future plans."
- A study looking at the roles and scope of practice of pediatric nurse practitioners found that the majority currently works in primary care and most do not have any inpatient roles. Independent pediatric nurse practitioner practices are not responsible for a significant portion of pediatric visits. Pediatric nurse practitioners are unlikely to alleviate the currently perceived shortage of pediatric subspecialists without a significant change in the pediatric nurse practitioner workforce distribution.
- A study looking at the roles and scope of practice of family nurse practitioners in the care of pediatric patients found that among family nurse practitioners who care for children, pediatric patients represent only a small fraction of their patient populations. Family nurse practitioners are unlikely to have a significant impact on the availability of either primary or subspecialty care for children in the future.
- A study looking at the roles and scope of practice of physicians assistants found that they can and do play an important role in the care of children in the United States. However, fewer than 3% are engaged in nonsurgical pediatric primary or subspecialty care. Thus, their role is limited by the relative scarcity of physician assistants currently engaged in pediatric practice.
- A study of the roles and scope of practice of neonatal nurse practitioners found discrepancies in their distribution across the country, which may impact care provision in NICUs in certain regions. Comprehensive studies that examine the demand for neonatal nurse practitioners and the roles of other clinicians in the NICU should provide a greater understanding of appropriate NICU workforce capacity and needs.
"This is a wake-up call," Freed says. "No one bothered to check whether or not there are more nurse practitioners and physician assistants available to provide care to children. Health care planners are making assumptions about a workforce that may not exist to the extent of their projections."
"Children are becoming a smaller and smaller proportion of the U.S. population. We must ensure that as our society ages, we have a sufficient medical workforce at all levels to address health care needs."
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