Too Few Nurse Practitioners Work In Primary Care In Oregon, Study Shows

Amid a shortage of primary care physicians across nearly all of Oregon, nurse practitioners can play a vital role in filling service gaps by providing the day-to-day health care services a family doctor may offer.

But just one-quarter of Oregon’s nurse practitioner workforce is actually providing primary care services, according to a recent study that suggests that more than 2,000 skilled medical providers are being underutilized at a time of record need.

The study by the Oregon Center for Nursing examined state licensing renewal forms that nurse practitioners fill out every two years. The center’s analysis found that just 745 of the more than 3,000 known practicing nurse practitioners provided primary care services in 2018, the most recent year state data were available.

Unlike registered nurses, nurse practitioners are trained to diagnose and treat a range of illnesses without a doctor’s supervision. They also have authority to write prescriptions and refer patients to specialists. Oregon is one of 23 so-called “full practice” states, which allow nurse practitioners to provide the full range of evaluation, diagnostic and prescribing services of a primary care physician.

But the proportion of Oregon nurse practitioners actually serving in this role is far fewer than the average cited by the American Association of Nurse Practitioners. It says more than 75% of nurse practitioners across the country provide primary care but the Oregon study only identified about 25%.Either Oregon is an anomaly or far fewer serve as primary care practitioners, officials at the nursing center said.  The study highlights a missed opportunity to fill crucial primary care staffing shortages across Oregon, said Dr. Rick Allgeyer, the Oregon Center for Nursing’s research director and author of the study.

“We have to take full advantage of the training of nurse practitioners in Oregon,” Allgeyer said in a briefing Wednesday. “We just simply don’t have enough primary care providers.”

Oregon needs nurses of all kinds, to be sure. The Oregon Employment Department projects the state will need to hire about 2,600 new nurses each year from 2017 to 2027 to replace retiring nurses and account for population growth.

But the shortage is coupled with an urgent need for doctors in rural parts of the state, said Jana Britton, the Oregon Center for Nursing’s executive director.

“There’s significant evidence that there is a lack of physicians and that rural communities lack primary care coverage,” Britton said. “Those could be filled by nurse practitioners.”

The number of nurse practitioners and registered nurses in Oregon continues to grow at rates between 7% and 8% each year, Allgeyer said. But just 53% of nurse practitioners are working in primary care clinic or office settings where they could help fill the need for primary care, as opposed to specialty clinics, hospital and ambulatory or emergency department settings where their work more closely resembles that of registered nurses.

The study didn’t make any conclusions about the reasons for this misalignment. But factors like higher pay in specialized settings and a higher concentration of nurse practitioners in urban areas where physician shortages are less severe may make them less incentivized to seek roles where they could practice primary care, Bitton said.

Meanwhile, parts of every Oregon county except for Multnomah and Washington were listed as federally recognized primary care shortage areas as recently as 2017.

“In light of said shortages for primary care physicians, a lot of people that deal with this workforce in health care have been arguing that nurse practitioners are in a perfect position, especially in full practice states like Oregon, to fill the gap where there isn’t as much availability of primary care physicians,” Allgeyer said. “We want to see that additional capacity in Oregon’s nurse practitioner workforce in terms of dealing with primary care.”

You can reach Elon Glucklich at [email protected].

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