Analysis | Like doctors, more nurse practitioners are heading into specialty care (2024)

If nurse practitioners leave primary care, who’s left?

If your doctor can’t see you now, maybe the nurse practitioner can.

Nurse practitioners have long been a reliable backstop for the primary-care-physician shortfall, which is estimated at nearly 21,000 doctors this year and projected to get worse.

But easy access to NPs could be tested in coming years. Even though nearly 90 percent of nurse practitioners are certified to work in primary care, only about a third choose the field, according to a recent study.

Health-care workforce experts worry that NPs are being lured toward work in specialty practices for the same reason that some doctors steer clear of primary care: money.

“We get what we pay for,” said Candice Chen, an associate professor of health policy and management at George Washington University.

Physicians must do a residency and usually a fellowship, and pass muster with a national certifying body to practice in a specialty such as oncology or endocrinology. But NPs generally don’t need to be endorsed by a standard-setting group before transitioning to specialty care.

There are advanced programs in specialties such as endocrinology or dermatology that they can enroll in if they wish, but it’s not required.

There’s not much data on salary differences among NPs, but according to AMN Healthcare Physician Solutions, a staffing firm, specialist NPs and physician assistants make about $6,000 more annually on average than those in general practice.

In Yankton, S.D., nurse practitioner Raina Hoebelheinrich is studying for a certificate in endocrinology from a local university to boost her knowledge and increase treatment options for patients with diabetes who otherwise may have to drive hundreds of miles to see a specialist.

“I’ve experienced firsthand with family members the difficulty getting in to receive this type of care,” she said.

She said she’s not sure how she’ll use her new skills. But they’ll surely expand her employment options, even in rural America.

There’s not a lot of data, but some evidence points to nurse practitioners moving away from primary care. The Milbank Memorial Fund’s 2024 primary care scorecard found that between 32 and 34 percent of NPs worked in primary-care practices from 2016 to 2021.

Meanwhile, “nurse practitioner” is one of the fastest-growing occupations, according to the federal Bureau of Labor Statistics, projected to grow 45 percent and add 123,600 jobs by 2032. The staffing firm AMN says NPs have been the most requested position search from their clients for three years running.

Atul Grover, executive director of the Research and Action Institute at the Association of American Medical Colleges, said the numbers indicate there are probably ample NPs, physician assistants and physicians to meet primary-care demand in the future. At the same time, “expect more NPs and PAs to also flow out into other specialties,” he said.

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House passes defense policy bill targeting abortion, gender-affirming care

The House passed its version of the annual defense policy bill Friday after Republicans added a slew of culture war amendments, setting up a showdown with the Democratic-led Senate over historically bipartisan legislation, The Post’s Abigail Hauslohner reports.

The $895.3 billion National Defense Authorization Act was approved by a vote of 217-199, falling mostly along party lines.

A closer look: One of the GOP’s most hard-line amendments, from Rep. Beth Van Duyne (R-Tex.), would prohibit the Defense Department from covering travel expenses for U.S. service members or their family members seeking abortions. Republicans also adopted a proposal to block funding for gender-affirming care for transgender troops.

Meanwhile, across the Capitol: The Senate Armed Services Committee announced completion of its $923.3 billion defense bill. Sen. Tim Kaine (D-Va.), a senior member of the panel, said he’s not worried about reconciling the legislation with the House bill and predicted many items on the far right’s wish list would fall by the wayside, as they did last year.

In other news from Capitol Hill …

Novo Nordisk CEO Lars Jorgensen has agreed to testify voluntarily before the Senate Health, Education, Labor and Pensions Committee at a hearing later this year focused on U.S. prices for Ozempic and Wegovy, dodging a subpoena threatened by Chair Bernie Sanders (I-Vt.).

Republican leaders of two House committees are seeking stakeholder feedback on a proposal to reform and restructure the National Institutes of Health. The plan would reduce the agency’s 27 institutes and centers to 15, set term limits for its leaders and bolster congressional oversight of its funding, among other actions.

Advocates press federal health officials on mpox research

LGBTQ+ health advocates and scientists urged the Biden administration to escalate efforts to research mpox and increase vaccination in a letter Friday, our colleague Fenit Nirappil reports.

While mpox cases have drastically declined since a 2022 outbreak, the advocates say federal officials must act proactively if the virus, including a potentially deadlier version, surges again. The letter was coordinated by Prep4All, an HIV prevention group, and StickItIn, which advocates for mpox vaccines.

They urged the United States to join forces with other countries studying the effectiveness of TPoxx, an antiviral mpox treatment, because the U.S. study has not enrolled enough participants.

Citing data showing that antibodies wane within a year of vaccination with Jynneos, the only mpox vaccine approved by the Food and Drug Administration, they also called for randomized controlled trials to investigate whether a third dose would boost immunity. Federal officials have said two shots is enough.

But access to free vaccines is set to expire within months when the Jynneos vaccine hits the commercial market, the advocates said. They urged federal officials to find a way to keep distributing shots at no cost.

“We must immediately correct course for the ongoing health of our communities and to ensure our nation’s biosecurity,” the letter said.

Texas high court declines to decide if embryos are people or property

The Texas Supreme Court on Friday declined to consider whether frozen embryos are people or property in the eyes of the law, a ruling that could have significant implications for in vitro fertilization in the state, The Post’s Molly Hennessy-Fiske reports.

“I’m happy that IVF stays the way it is,” said Patrick Wright, the attorney for the prevailing party in the case, who was sued amid a divorce. Yet he cautioned that the issue is likely to resurface during next year’s legislative session. “This is just the start.”

Key context: The case was brought by a Dallas-area woman after Roe v. Wade was overturned in 2022, triggering a Texas law making abortion a felony punishable by up to life in prison. That law, Caroline Antoun argues, requires her three frozen embryos to be treated as children in her divorce instead of property to be divided.

“What’s at stake is my ability to protect my unborn children,” Antoun said, insisting that while antiabortion groups have supported her, she’s not against abortion but for personhood and parents’ rights. “The current law is failing us.”

Antoun could still appeal the case, including to the U.S. Supreme Court.

📅 Welcome back! It’s a quiet week on Capitol Hill, as House members are working in their districts.

One notable event is the Senate Homeland Security and Governmental Affairs Committee hearing on Tuesday, where lawmakers will examine evidence related to the origins of covid-19.