Growing trends for Advanced Practice Providers
Advanced Practice Providers do more than just deliver care - they are fundamental to medical education, mentoring, clinical and basic science research, and they are important advocates for many different patient populations.
Since the implementation of the Affordable Care Act (ACA), the number of advanced practitioners has risen. This is due to the increased effort to reduce costs and the result of the expanded number of people who now have healthcare coverage, combined with a shortage of doctors. The Bureau of Labor Statistics estimates that the number of physician assistants in the healthcare workforce will grow 30.4% between 2014 and 2024.
The success of APPs is clear and has been acknowledged by researchers and healthcare providers alike, and their role has become paramount in medical subspecialties and intensive care units. However, even more critical is their role in primary care, as evidenced by provisions included in the ACA, which recognized APPs need to play an essential part in addressing the current and projected primary care shortage. The Affordable Care Act even went so far as to formally acknowledge physician assistants and nurse practitioners as two of the three categories of primary care providers, along with doctors. (1)
Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions.
Listed below are the many types of the fastest growing areas for APPs, along with their responsibilities:
Nurse Practitioners:
Pediatric Nurse Practitioner:
A Pediatric Nurse Practitioner (PNP) specializes in caring for newborns, infants, toddlers, adolescents and young adults. PNPs focus on well-child care and the prevention or management of common pediatric acute illnesses and chronic conditions.
Nurse Midwifery
A nurse midwife is an advanced practice registered nurse who specializes in the care of women, including those expecting to give birth. Though they can perform births, and a nurse midwife also works with mothers before, after, and during the delivery to give the best care to both mother and child. They can also provide care for newborns up to 28 days old.
Neonatal Nurse Practitioner
A neonatal nurse practitioner will provide intensive care for full term and premature infants who generally have health problems.
Oncology Nurse Practitioner
Oncology nurses provide specialist care for individuals who have cancer, working one on one with them during their time in hospital, and at home.
Geriatric or Gerontological Nurse Practitioner
A geriatric nurse practitioner works primarily with elderly patients, typically within a hospital or care home. A geriatric nurse is trained specifically to handle the kind of challenges an elderly patient deals with, such as chronic illnesses, dementia, arthritis, and other long term conditions.
Psychiatric Nurse Practitioner
A psychiatric nurse has a higher degree of expertise regarding mental health, and they can help patients to deal with addictions, mood disorders, drug abuse and anxiety.
Chronic Pain Nurse Practitioner
Chronic pain management nursing is considered to be a vital part of the medical field, as it helps to improve the quality of life for patients.
House Call Nurse Practitioner
This is mostly for people who need assistance for their elderly family after being released from the hospital. You will offer care to prevent them from hospital readmission.
Clinical Nurse Specialist
A clinical nurse specialist is expected to deal with and treat patients who struggle with chronic and serious health conditions. Usually, they will work with these patients in a clinical setting, and the individual in question may suffer from an acute illness.
Nurse Advocate
A nurse advocate represents the interests of the patient and the patient’s family when in a clinical care or hospital setting. Family nurse practitioners are often used to this role, as they work very closely with patients throughout their lives, providing an important link between them and other healthcare professionals.
Dialysis or Nephrology Nurse Practitioner
Patients with kidney problems often need dialysis regularly to filter their blood for them so that they can survive. As a dialysis nurse, you would be able to provide the care your patients need in this instance. (2)
Top Practice areas for Certified NP’s (2020 data)
Primary Care – Family Medicine ------------------- 65.4%
Primary Care – Adult Medicine -------------------- 12.6%
Primary Care – Gerontology ------------------------ 7.8%
Acute Care ---------------------------------------------- 5.5%
Primary Care – Pediatrics --------------------------- 3.7%
Acute Care – Gerontology -------------------------- 3.4%
Women’s Health -------------------------------------- 2.8%
Psychiatric / Mental Health ------------------------ 1.8%
Hospital and Palliative Care ------------------------ 1.5%
(NP’s can be certified in more than one area) (5)
Physician Assistants
Radiology Practice
Physician assistant specialties in this career include performing fluoroscopies, insertion and removal of IV catheters, and initial interpretations of scans or X-rays. They also assist in, perform, and monitor patients undergoing interventional radiology procedures such as central venous access, angioplasty, and embolization.
Dermatology Physician Assistant
PAs in dermatology treat a variety of skin conditions and diseases and work with patients wishing to undergo cosmetic surgery. Dermatological PAs are heavily involved in preoperative and postoperative workups and patient care as well as assisting in surgical procedures.
Urgent Care Physician Assistant
These types of assistant physicians working in walk-in clinics and urgent care give care for acute, but not emergent illness. They do procedures such as draining abscesses and suturing, plus treat and diagnose medical conditions like sprains and bronchitis.
Mental Health
Physician assistants in mental health treat and diagnose mental illness. They often manage their medication and offer crisis intervention, among other things. They usually work in hospitals with in-patient psychiatric units, prisons and jails, private mental health clinics, plus country mental health facilities.
Emergency Department Physician Assistant
While working in the emergency room, PAs, give care for patients who have acute illnesses. They work in both the main emergency department, plus in fast track settings. Physician assistants in the ER see patients with symptoms like abdominal pain and chest pain, plus perform procedures like draining abscesses and suturing.
Pediatric Practice
The Pediatric PA in inner-city and rural settings could be the only medical care provider available, except once or twice a week when a supervising doctor visits. Pediatric physician assistants therefore need to be self-starters who work good with children, can remain calm in emergencies and are emotionally sound. They can also check on patients in hospitals or make house calls, reporting their findings to the primary doctor. They do diagnosing, examining and treating children in clinical settings, plus mend minor injuries by putting on splints, sutures or casts. They also interpret x-rays and tests, plus perform various clerical duties.
Surgical Physician Assistant
These PAs work in the operative environment. They do pre-admission assessments, testing and act as first-assists in the operating room, plus give post-operative care. They could also work in step-down units and office-based practices. (6)
Neurosurgery
Physician assistant specialties in neurosurgery include assisting neurosurgeons while they operate mainly on the spine and brain.
Top Practice Areas for Certified PA’s (2019 data): (4)
Surgical Subspecialties ------------------------------- 18.7%
Family Medicine / General Practice -------------- 18.6%
Emergency Medicine --------------------------------- 12.8%
Internal Medicine Subspecialties ------------------ 9.5%
Internal Medicine / General Practice ------------- 4.5%
Dermatology -------------------------------------------- 4.1%
Hospital Medicine ------------------------------------- 3.5%
General Surgery ---------------------------------------- 3.0%
Pediatrics ------------------------------------------------- 1.9%
Psychiatry------------------------------------------------- 1.6%
References:
- com/sites/realspin/2017/03/16/advanced-practice-providers-are-key-to-americas-healthcare-future
- org/family-practice/the-top-15-career-path-options-for-family-nurse-practitioners/June 2020
- org/physician-assistant-specialties/ 2020
- NCCPA 2019 Statistical Profile of Certified Physician Assistants
- American Association of Nurse Practitioners – NP Facts, August 2020 data