Nonphysician providers in the hospitalist model: A prescription for change and a warning about unintended side effects

The current state of our profession is that the US population is aging rapidly, requiring ever more healthcare, and there is a stagnant number of physicians to care for them. The question of who will care for our aging population has been raised over and over in the past decade but the question is worth repeating. As our country continues to deliver stateof-the-art medical care, it is slow to embrace the notion that in order for it to continue, it will need to incorporate the professions of advanced practice nurses and physician assistants. Without these nonphysician providers our medical community will not be able to reach the patients we have sworn to treat. The percent of the US population age >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030. The number of persons age >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030, and the number of persons age >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030. Our aging America is also coupled with a growing physician shortage. In its report entitled ‘‘Physician Workforce Policy Guidelines for the United States, 2000-2020,’’ the Council on Graduate Medical Education recommended increasing the number of medical school graduates by 3000 per year by the year 2015 to meet the increasing need. Given the current trend of decreasing physician reimbursement coupled with the average medical school debt of $139,517, it is doubtful that the extra 3000 physicians needed to graduate in 2015 will actually ever do so. Despite this possible additional physician workforce, there still stands to be enormous need for the nonphysician provider with our rapidly expanding senior population. Our nation’s hospitals are by no means spared from our aging population or physician shortage. In fact, they are likely to be the hardest hit. Hospitalists are already feeling the pressure of an overstressed workforce coupled with increasing patient volume. There is a growing body of evidence supporting the successful collaboration between hospitalists and nurse practitioners (NPs)/physician assistants (PAs) (collectively, nonphysician providers [NPPs]). No longer are NPPs only working in outpatient practices or in the operating room, but they are actively involved with inpatient medical units improving our Hospital Medicine (HM) specialty. According to Myers et al., the hospitalist NP model improved program finances and increased physician and resident satisfaction. In order for Hospital Medicine to create increasing value for its parent hospital or to the community it serves, NPPs will need increased integration into our care model for improved overall efficiency. We focus herein on the advantages and potential benefits of NPPs relating to their varied roles within HM.