The Pros and Cons of Nurse Practitioner and Physician Assistant Role Expansion

Role expansion is a hot topic for nurse practitioners and physicians assistants as health care policymakers increasingly appreciate their value in health care. The journalMedical Care Research and Reviewhas published a new article ahead-of-print that discusses an important issue in fields where job opportunities and responsibilities are changing: job satisfaction.

Researchers at the School of Urban Affairs and Public Policy at Northeastern University in Boston, examined 16 years of literature on this topic and evaluated dozens of studies for quality, eventually including 32 in their report.

Citing 3 issues — insurance expansion pursuant to the Affordable Care Act, the aging US population, and increased morbidity among Americans–the authors acknowledge that nurse practitioners and physician assistants have become critical primary care providers. The nation depends on them to augment primary care, an area in which a physician shortage is looming.

Between 2004 and 2017, the number of practicing nurse practitioners more than doubled, and the Bureau of Labor Statistics indicates the physicians assistants will increase by 30% in number before 2024. More than 2000 primary care retail clinics across the United States account in large part for the expansion.

Now recognized as a "strategic necessity," role expansion for these 2 occupations has implications for job satisfaction, burnout, and work-related stress.

These researchers noted that both nurse practitioners and physicians assistants reported minimal- to-moderate levels of satisfaction, although a few studies reported high satisfaction rates. In general, these practitioners tended to be satisfied with their autonomy and sense of accomplishment but less satisfied with pay, schedule, and actual collaboration with other health care providers. Thus, the researchers noted, role expansion has positive and negative repercussions.

The researchers indicated a lack of studies that look at a wide range of work-related factors for nurse practitioners and physicians assistants. Most currently available data heavily emphasizes job satisfaction, and lacks information about burnout, job stress, and intent to change jobs.

Previous studies have found annual turnover levels for nurse practitioners and physicians assistants to be between 8% and 12%. The researchers concluded that the health care industry needs more information about nurse practitioners and physicians assistants if they are to recruit, develop, and retain these important primary care providers.

Reference

Hoff T, Carabetta S, Collinson GE. Satisfaction, Burnout, and Turnover Among Nurse Practitioners and Physician Assistants: A Review of the Empirical Literature.Med Care Res Rev.2017 Sep 1:1077558717730157. doi: 10.1177/1077558717730157. [Epub ahead of print]