The Trend Towards NP & PA Specialization: Will You Stay in Primary Care?

Yes, I am a sellout.  I was educated as a Family Nurse Practitioner, worked in a family practice clinic for a year then opted out for the significantly larger paycheck that comes with working in the emergency department.  Like myself, many physicians, NPs and PAs are leaving primary care or choosing not to enter the general medicine field at all instead choosing specialty practice.

Currently, only 14.6 percent of physicians work in primary care with just 25 percent of newly graduating medical students going into the field.  Of these 25 percent of new doctors entering primary care, many plan to sub-specialize making the number of physicians planning to practice in the primary care setting even more dismal.

The number of physician assistants employed in the primary care setting are better than those for MD's but not by much.  Between 1996 and 2010, the percentage of physician assistants working in primary care fell from 51 percent to 31 percent.

While nurse practitioners have traditionally prided themselves on their origins in public health and continued commitment to primary care, NPs are jumping on the specialization bandwagon alongside PAs and MDs.  Nurse practitioners are exiting primary care in larger and larger numbers  electing to practice in more specialized settings.  Although 84 percent of nurse practitioner students study primary care in their NP programs, only 55 percent end up working in a primary care practice. 

Why are healthcare providers shying away from primary care?  Some become disillusioned with unnecessary red tape of medical practice.  Idealistic students enter the profession in hopes of helping their patients only to be taught that insurance company and government regulations make it difficult to do so.  The healthcare reimbursement system is biased toward specialists paying high rates for procedures and almost nothing for time-consuming tasks like encouraging smoking cessation, promoting healthy eating and teaching new mothers the basics of childcare.  Primary care just doesn't pay. 

With healthcare reform on the horizon Americans are clamoring for more providers to enter primary care.  But, the crux of the problem is money.  You can't blame providers for choosing higher paychecks over becoming PCP's.  Only by changing the way primary care providers are paid will more NPs, PAs and MDs choose the family practice clinic over the allure of high paying specialties.