title: Gaps in the supply of physicians, advance practice nurses, and physician assistants.
abstract: BACKGROUND
  Based on the goals of health care reform, growth in the demand for health care will continue to increase the demand for physicians and, as physician shortages widen, advanced practice nurses (APNs) and physician assistants (PAs) will play larger roles. Together with physicians they constitute a workforce of "advanced clinicians." The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services.
  
  
  METHODS
  Projections were constructed to the year 2025 for the supply of physicians, APNs, and PAs, and these were compared with projections of the demand for advanced clinical services, based on federal estimates of future spending and historic relationships between spending and the health care labor force.
  
  
  RESULTS
  If training programs for APNs and PAs grow as currently projected but physician residency programs are not further expanded, the aggregate per capita supply of advanced clinicians will remain close to its current level, which will be 20% less than the demand in 2025. Increasing the numbers of entry-level (PGY1) residents by 500 annually will narrow the gap, but it will remain >15%.
  
  
  CONCLUSIONS
  The nation faces a substantial shortfall in its combined supply of physicians, APNs, and PAs, even under aggressive training scenarios, and deeper shortages if these scenarios are not achieved. Efforts must be made to expand the output of clinicians in all 3 disciplines, while also strengthening the infrastructure of clinical practice and facilitating the delegation of tasks to a broadened spectrum of caregivers in new models of care.
authors: School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Michael
authors: M
authors: Sargen
authors: Roderick S
authors: RS
authors: Hooker
authors: Richard A
authors: RA
authors: Cooper
mesh_terms: D000328:Adult; D057179:Advanced Practice Nursing; D005260:Female; D018166:Health Care Reform / Q000592:standards / Q000639:trends; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data / Q000639:trends; D006280:Health Workforce / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000600:supply & distribution*; D010823:Physician Assistants / Q000600:supply & distribution*; D010820:Physicians / Q000600:supply & distribution*; D011320:Primary Health Care; D014481:United States / Q000453:epidemiology