Advanced Practice Nurses
Recent issues have converged nationally and in Colorado that challenge the ability of the health care workforce to meet the future demand for primary care. While demand is difficult to pinpoint, the increasing portion of the population aged 65 and older and their associated higher disease burden are changes expected to pressure the health care system and its workforce. Analysis conducted by the Colorado Health Institute (CHI) estimates state and federal health reform will extend some form of coverage to 510,000 Coloradans currently without health insurance. Even where the supply of primary care physicians is sufficient, uneven geographic distribution may cause shortages on a local level, particularly in rural areas.
Advanced practice nurses (APNs), specifically nurse practitioners, are one type of non-physician clinician providing quality primary care in Colorado. APNs are licensed registered nurses prepared at the graduate degree level as a clinical specialist, nurse anesthetist, nurse-midwife or nurse practitioner. Those involved in primary care are expected to play an increasingly important role in nurse-managed health clinics and patient-centered medical homes. A lack, however, of detailed and reliable information about APNs and other non-physician primary care clinicians limits robust primary care workforce planning in Colorado.
Over the past several decades, federal and state policymakers have worked on developing an effective workforce policy in response to a primary care workforce that is not meeting the health care needs of many communities. In the next decade and beyond, Colorado, like the rest of the United States, faces a rapidly aging population. In addition, there will be increased demands for care from the newly insured as a result of the federal Affordable Care Act, the federal health reform bill.
Adding to the challenge of ensuring that Colorado will have the health care workforce capacity it needs is the fact that the workforce is aging and many members are approaching retirement age. Colorado also has shortages in some geographic areas because the physician workforce is not distributed evenly. The majority of health care professionals prefer to practice in urban or suburban settings, leaving large numbers of rural communities with inadequate or no primary care resources.
Health services research over the past 30 years has found that the introduction of the physician assistant (PA) profession in the early 1970s has been one of several promising strategies to expand the primary care workforce, particularly in rural and other underserved areas.