There is a physician shortage in the United States. In Western countries physicians hold a near monopoly on patient care. I often say the most expensive piece of medical equipment is the physician’s pen, because licensed physicians must authorize all the nearly $4 trillion worth of medical care provided annually. Yet, there is a shortage of physicians in the U.S., especially physicians working in primary care. Medical doctors is slowly abandoning primary care because it pays less than medical specialties. Primary care are those frontline doctors we all see for routine care, like family practitioners, internists, OBGYN, pediatrics. By 2038 – roughly a dozen years from now – the shortage of physicians will grow to about 141,000 physicians.
Advance practice nurses, such as nurse practitioners (NPs), are picking up some of the slack left by doctors of osteopathy (DOs) and medical doctors (MDs). NPs can do many of the same patient care tasks that physicians perform but with less training and at lower pay. The following is from the Wall Street Journal:
These days, heading to the doctor’s office often doesn’t involve a doctor. At least not directly. Instead, nurse practitioners have become major gap fillers, growing their ranks by 60% to 461,000 between 2019 and 2025, data from the American Association of Nurse Practitioners show.
“There is a place for medical-school doctors, and a place for nurse practitioners. And all of us are trying to do the same thing, which is meet the needs of people who need help,” said Peterson.
Physicians tend to jealously guard their turf and frequently remind people that doctors have 10,000 more hours of training than NPs. Yet, MDs and DOs have largely abandoned primary care for specialties. Physicians support the use of NPs and PAs, but argue that NPs/PAs role should report to physicians and work alongside them, not compete against physicians.
About half of states grant NPs full practice authority. Some states require physician supervision, while others allow collaboration. Collaboration allows more independence than supervision, which often limits the number of NPs one doctor can supervise.
NPs paved the way for so-called midlevel practitioners, and physician assistants (PAs) soon followed. PAs perform a similar role. An NP degree used to be a master’s degree program but was elevated to a doctorate a few years ago. Nurses having a doctorate further irritated many physicians, who claimed it would confuse patients. Multiple states have passed laws limiting or restricting who can use the honorific title, “Doctor” in health care settings.
Is there a lesson for pharmacists? Pharmacists are sometimes referred to as the most overeducated, underutilized professional in health care. Pharmacists know more about drugs and chemistry than any other professional in the health care setting. They can assist with chronic disease management. The following is from Drug Store News:
To better serve patients, many pharmacists are expanding their clinical service offerings by providing immunizations, conducting point-of-care testing, offering treatment management and supporting chronic disease monitoring.
Idaho, Colorado, and Montana have expanded pharmacists prescribing authority for various minor ailments. California, North Carolina, Florida, New Mexico, and Oregon have also expanded the number and types of medications pharmacists can dispense without a doctor’s prescription. One obstacle, although a minor one, is how to reimburse pharmacists for their skills if consulting with patients. A straightforward way to increase access to care, while increasing the role of pharmacists, would be to create a class of drugs that pharmacists are allowed to dispense without a doctor’s prescription. These are sometimes called, behind the counter drugs. That is, prescription drugs must be prescribed by a physician. Over-the-counter drugs are safe enough to self-medicate by patients themselves. A third class of drugs (behind the counter) are ones patients can request only receive after guidance from a pharmacist. Creating a third class of drugs and refining the circumstances when pharmacists could dispense them would allow millions of Americans to treat chronic problems, and routine medical needs, with less hassle and better access to care.
Read more at:
WSJ: Nurse Practitioner Is Now the Hottest Job in Healthcare
Cicero Institute: 2025 Policy Strategies for Full Practice Authority
Cato Institute: Overlicensed and Underused: Rethinking Pharmacy’s Role in Health Care