On January 11, US News and World Report published their 2017 Best Jobs list and 52 of the top 100 are in health care. Nurse practitioner and physician assistant are number two and three on that list with no surprise as the demand for more skilled health care professionals skyrockets. Susannah Snider, personal finance editor at U.S. News said in a press release about the jobs list, "Health care jobs often require a human element, so they can't be exported or entirely replaced by robots – at least not yet.

 

“Continued growth in the health care sector, low unemployment rates and high salaries make these jobs especially desirable. Plus, individuals can pursue a range of health care positions that require varying levels of skill and education," furthered Snider. While the opportunities for PAs and NPs expand practically every specialty — orthopedics, endocrinology, cardiology, pediatrics — a reported 80% of nurse practitioners choose primary care whereas a study from the National Commission on Certification of Physician Assistants (NCCPA) states physician assistants tend to practice outside of primary care. 

 

Regardless of the position a person chooses, it’s all good news for CNHP. The Bureau of Labor and Statistics cited nurse practitioner and physician assistant among the fastest growing occupations with 35% and 30% growth respectively. This expansion can be attributed to a few factors including a move to patient-centered care models and an aging population. But another reason is the expansion of coverage for an additional 20 million people through Affordable Care Act. “The ACA recognized physician assistants as an essential part of the solution to the primary care shortage by formally acknowledging them as one of the three primary care health providers,” said Patrick Auth, PhD, MS, PA-C, CNHP clinical professor and department chair. “They also committed to expanding the number of PAs by providing financial support for scholarships and loan forgiveness programs, as well as by funding the training of 600 new PAs,” he continued.

 

“The Affordable Care Act (ACA) allowed millions of Americans to have access to insurance to pay for the cost of their health care. That meant hospitals and providers reduced their cost of indigent care.  While these figures have presented a hopeful outlook on what new health care reform may mean, one recent report has portrayed a potentially much different outcome.

 

The study conducted by the Commonwealth Fund revealed repealing the ACA, likely starting with the insurance premium tax credits and the expansion of Medicaid eligibility would result in a doubling in the number of uninsured Americans while having widespread economic and employment impacts. In 2019, the study predicts a loss of 2.6 million jobs nation-wide, primarily in the private sector, with around a third of them in the health care industry. Pennsylvania could see around 137,000 jobs lost. 

 

Elizabeth W. Gonzalez, PhD, PMHCNS-BC, associate professor and department chair of the doctoral nursing program and Kymberlee Montgomery, DrNP, CRNP-BC, CNE ’09, associate clinical professor and department chair of the nurse practitioner program, both suggest that it is too early to tell what any real impact will be to healthcare or employment. “The ACA also lowered Medicare spending by allowing people to enter into share savings plans with accountable care organizations where providers are reimbursed based on the quality, not the quantity, of their services,” Gonzalez said. “This emphasis on quality has resulted in significant savings, lower cost of health care for seniors, individuals with disabilities, low income families, and children. The ACA encourages a focus on the patient experience and this has led to some wonderful innovations because clinicians are being paid to focus on ways to enhance the quality of the care they provide patients,” she added. 

 

“The Affordable Care Act introduced patients to the role of the nurse practitioner. Patients were forced to see us for primary care — nurse practitioners provided care at a lower cost,” stated Montgomery. “Now patients want to see us because of the level of care we provided.” There are just so many unknowns where the ACA is concerned. While the current administration seems determined to repeal the law, they haven’t yet put forth a replacement that will provide affordable healthcare for those who would undoubtedly lose what they currently have. It’s uncertain whether a new law might be proposed that would guarantee that no jobs created under the ACA are lost or if patient outcomes will decline.” But both Gonzalez and Montgomery feel that advanced practice nursing will continue to be a cost effective way to deliver outstanding clinical services. While it’s tough to speculate, Montgomery thinks opportunities for nurse practitioners will continue to grow regardless. “Who knows, it might make it better for the nurse practitioner especially because we provide high-quality, comprehensive care at lower costs,” she said.