HealthJuly 30, 2020

The role of nurse practitioners and physician assistants during COVID-19

By: Suneel Dhand, MD

The pressures of COVID-19 have highlighted the role of nurse practitioners and physician assistants in crisis healthcare delivery.

The COVID-19 pandemic has stretched the healthcare system and tested front-line staffing models across the country. As an internal medicine doctor practicing hospitalist medicine, I've found myself working in a variety of healthcare facilities, all with their own unique staffing setup.

When the pandemic first arrived, our immediate concern was whether we would be overwhelmed and not have enough doctors to treat the sick. However, even before COVID-19, many facilities were struggling to find enough physicians. An aging population and rising chronic comorbidities were already leading to surges in demand that were difficult to meet. Nurse practitioners and physician assistants have helped greatly with this problem.

The role of nurse practitioners and physician assistants

How does these advanced practitioners' training compare with that of physicians?

A typical Doctor of Medicine (MD) in the United States has completed four years of undergraduate college, four years of medical school and then anything from three to seven years of medical residency and fellowship training. In contrast, a nurse practitioner (NP) may or may not have been a clinical nurse first and has to complete a master's degree in order to earn that title; this typically takes two to four years after getting a basic nursing degree. Meanwhile, a physician assistant (PA) has completed at least two years of specialized training (many have already earned healthcare-related undergraduate degrees beforehand).

After graduating, an NP or a PA often goes straight into their chosen specialty, working closely with a physician. As advanced practitioners gain more experience, they begin to practice more independently.

In primary care, there's predicted to be a shortage of over 55,000 doctors within a decade, according to the Washington Post, and so NPs and PAs are fast becoming the backbone of our system. Research suggests that they provide high-quality care to their patients. For instance, a large study published last year in the Journal of the American Academy of Physician Assistants showed that there were no differences in diabetes outcomes based on whether a patient's clinician was a physician, PA or NP and that patients could safely be managed by either profession in a primary setting. These heartening results show that both NPs and PAs are well-prepared to meet the challenges of delivering healthcare alongside physicians over the next few decades.

To learn more about the role of nurse practitioners and physician assistants and earn CME credits, listen to "Comparing 3 Types of Primary Care Providers" on AudioDigest.

What has COVID-19 meant for PAs and NPs?

There are currently almost 300,000 nurse practitioners and 123,000 physician assistants in the United States, according to the American Association of Nurse Practitioners and the American Academy of Physician Assistants. Most have vast clinical experience and it would be a tremendous lost opportunity if they were not fully utilized at the top of their licenses during this pandemic.

But what is the role of nurse practitioners and physician assistants in this time of crisis, especially in hospital medicine? Here's a look at some models that have been adopted.

1. Newly expanded roles

The previous model of having our NPs and PAs see a certain number of patients under direct physician supervision has been replaced in some cases by allowing the more experienced clinicians to manage their patients — usually less medically acute cases — with a higher degree of autonomy. While the physicians will always be available for questions and concerns, essentially independent practice is allowed for mid-level practitioners, provided they are comfortable with it. This also frees up physicians to see more patients of higher acuity, which we were anticipating during the beginning of the pandemic.

2. Movement across specialties

Due to the almost nationwide cancellation of elective procedures and surgeries, many mid-level practitioners in surgical specialties have found themselves either out of work completely or with fewer weekly shifts, so hospital medicine programs have been bringing these clinicians in to help out. After some training, they are ready to work in a new capacity, albeit with more supervision than a seasoned medical mid-level.

Bringing in mid-level practitioners has allowed these clinicians to keep working while greatly relieving pressure on the acute care front lines.

3. Outpatient appointments and COVID testing

Hundreds of thousands of patients have been presenting with suspicious symptoms and requesting testing at primary care clinics, urgent care centers and ad hoc testing centers. NPs and PAs, many of whom have already been working in primary care, are ideal staff for these centers. There is still a large demand, particularly in cities and suburban areas, for clinicians to work in these facilities.

The last few months have been hugely challenging for all healthcare professionals. The efforts of medical doctors have been widely acknowledged in the media, but the role that mid-level practitioners have played must be praised, too.

Suneel Dhand, MD