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How Kentucky's Nurse Practitioners Are Filling the Void Left by a Physician Shortage

The Affordable Care Act may have given an estimated 32 million Americans health insurance, but it hasn't provided more physicians to keep up with a growing patient population.

Enter the nurse practitioner.


Melissa Lamaster is the primary care provider at KentuckyOne Primary Care in Jeffersontown. She and two other nurse practitioners have been running the office, sans a physician, since it opened in the spring.

"I think most people are understanding what the role is as a nurse practitioner. When they come and they see a nurse practitioner they understand that we are able to access and diagnose and treat the same way a physician would," she said.

Nurse practitioners can provide much of the same care as general physicians—with some limitation—and are required to have different training.  And they're nothing new. The first nurse practitioner program was develop at the University of Colorado in 1965. But with more people gaining insurance coverage due to the ACA and Medicaid expansion, a shortage of doctors has become more apparent.

The Association of American Medical Colleges' Center for Workforce Studies estimates a shortage of more than 136,000 physicians by 2025.

The shortage stems from several factors, said Dr. Ron Waldridge, a Shelbyville physician and the chairman of KentuckyOne's Medical Group Board. The U.S. has an aging population that will need more medical care, and also the Affordable Care Act has led to more insured people, either through the insurance exchanges or the expansion of Medicaid.

Other factors include the cost of medical school to a decrease in government funding, he said.

Waldridge said physicians are under more pressure to accept new patients with more people having access to care, but it's not realistic to think that doctors alone will be able to provide the needed care.

"A lot of physicians, for example, were already seeing as many patients as they could. So, when the ACA and Medicaid expansion rolled around it wasn't like they could just start seeing more people because they were already pretty strapped," he said.

The need for more medical professionals is differs by location. The AAMC report also states that the shortage will severely impact people living in rural areas and inner-city locations designated as health professional shortage areas.

The Kentucky Cabinet for Health and Family Services lists three neighborhoods in Jefferson County as health professional shortage areas: Buechel/Newburg, Shawnee-Chickasaw and South Central Louisville-Louisville South.

The top two neediest counties border Louisville—Bullitt and Spencer. The southwestern part of the state has the highest need for primary care physicians, while the eastern part of the state has the lowest need.

A study by the Kentucky Health Benefit Exchange and the consulting firm Deloitte found that in 2012, 61 percent of the state's need for physicians were in rural counties.

So there is a need for more medical professionals to take care of patients' primary care needs.

Nurse practitioners fill that void, said Waldridge.

"The new area of healthcare is trying to  get people taken care of in the right place, at the right time, by the right people. Nurse practitioners are going to have a role to play in that as part of the team that takes care of the folks in our communities," he said.

Earlier this year, Gov. Steve Beshear signed into law Senate Bill 7, which expanded the prescribing authority of nurse practitioners in Kentucky.

A report by HHS states that nurse practitioners and physician assistants could somewhat alleviate the primary care physician shortage if they are integrated into the health care delivery system.

If fully utilized, physicians would remain the dominant providers of primary care, only decreasing from 77 percent of the primary care services in 2010 to 72 percent in 2020.

The Bureau of Labor Statistics reports that employment for nurse practitioners is expected to grow 31 percent between 2012-2022, which is much faster than the average for all occupations.

So, are nurse practitioners replacing doctors?

Waldridge and Lamaster said absolutely not.

"There's always a place for the physician," Lamaster said. "Nurse practitioners work collaboratively with the physician and that will always be the case."