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Obamacare's Problems Are Making Nurses and PAs The Big Winners In Health Care Reform


There are winners and losers in President Obama’s effort to remake the U.S. health care system, and two of the big winners are nurse practitioners (NPs) and physician assistants (PAs). Both will get to do more and make more in the new health care landscape.

In urban areas, patients may visit with the nurse or PA first before seeing the doctor, and in some cases an NP or PA may be their only care provider, unless there is a complicated medical problem.

In rural areas, an NP or PA may be the only provider available for miles.

Nurse practitioners and physician assistants have long wanted to take on a more responsibilities—referred to as “scope of practice”—both in delivering primary care and even some specialty care. Obamacare is greatly accelerating that trend.

First, efforts to reduce the cost of care are squeezing physicians’ fees, so many are turning more responsibilities over to NPs and PAs, who tend to cost less than a doctor.

Second, Obamacare has expanded the number of people with health coverage, and especially Medicaid, the federal-state health insurance program for the poor.

Many of those patients are now trying to see a doctor, which is a good thing, but are finding that many doctors aren’t taking new patients, and especially Medicaid patients.

Third, the country was already facing a shortage of doctors, but Obamacare is exacerbating the problem. Many doctors getting close to retirement are fed up with the new regulations and problems created by the legislation and so are retiring early.

Now NPs and PAs are filling that growing provider void.

As the PBS NewsHour reported a few years ago: “The scope of what nurses can do medically has also been growing for the past decade, at a time when the pool of primary care, or family doctors, has been shrinking. … And more and more are working on their own, especially in poor inner-city neighborhoods and rural areas, where there are few doctors in private practice.”

And states are facilitating that transition. The New York Times, citing the American Association of Nurse Practitioners, says that 20 states have adopted, and eight more are considering, laws allowing nurses with advanced degrees to practice in several medical areas without a doctor overseeing the care.

The U.S. Bureau of Labor Statistics (BLS) predicts that the registered nurse (RN) will be the fastest growing profession between 2008 and 2018.

And NPs and PAs make good money. BLS says the mean hourly wage for PAs (2014) was $46.77, or $97,280 a year. And slightly higher for NPs, $47.11 per hour, or $97,990 per year.

However, those incomes are just a little more than half of the median physician’s income of $187,200, according to BLS, which means that both NPs and PAs have room to climb as demand and their scope of practice increase.

But here’s the problem: There is nothing wrong with expanding NP and PA responsibilities, if that decision is being made in the context of doctors and nurses looking for ways to provide quality patient care at a reasonable cost.

My dermatologist is a nurse practitioner working under a physician, and that relationship works very well, at least as far as I’m concerned.

And certainly many NPs and PAs are stepping in to provide care where little or none is available, such as in rural areas and inner-cities.

But many of the current changes are being forced from top-down Obamacare regulations and price controls that leave health care providers scrambling to find a way to exist under Washington-imposed regulations. Think of it as: If you like your doctor, you can keep your nurse.

Nurse practitioners and physician assistants are going to be big winners under Obamacare. Let’s just make sure that patients and quality of care aren’t the losers.