Tipping Point Ahead: Prepared for a New Primary Care?


Primary care "is at grave risk of collapse," proclaims a report from the American College of Physicians, as printed in the July 7th issue of Medical Economics.1 A confluence of changing demographics within the medical profession and increasing consumer demand for health care services has brought our nation's primary care system to a tipping point. Market forces that continue to draw primary care providers (PCPs) away from patients, draw in Nurse Practitioners (NP) and Physician Assistants (PA) in a compensatory response. This is well documented as a declining national trend in PCPs and a corollary increase in NPs and PAs.

This health care tipping point is evidence based. The American Medical Association, the American College of Physicians, the Robert Graham Center, and the U.S. Department of Labor cite a shortage of primary care physicians, and some medical leaders and work force experts predict a more serious shortage in the future.

  • Challenged by the first wave of 78 million baby-boomers turning sixty this year, the American Medical Association (AMA) announced that there is "a shortage of physicians, at least in some regions and specialties, and that evidence exists for additional shortages in the future."2
  • The Robert Graham Center warns that "a persistent, six-year trend in the choice of specialty training by U.S. medical students threatens the adequacy of the physician workforce of the United States."3
  • The U.S. Department of Labor ranks physician assistant as one of the fastest growing occupations through the year 2014, and projects "patients relying more on other health care providers-such as physician assistants, [and] nurse practitioners."4

In response to increasing clinical demand, NPs and PAs practice with greater autonomy and prescribe more medication than ever before - approximately 750 million prescriptions/year.5 NPs and PAs collectively represent a major component of our present and future national health care delivery system, yet they have historically been considered secondary targets by the pharmaceutical industry.

In order to provide effective educational opportunities and product information to this rapidly evolving medical community, pharmaceutical companies must expand their spheres of awareness and attention with a two-fold approach that includes both promotional and educational initiatives.

Promotionally, the pharmaceutical industry should encourage their representatives to spend as much "face time" with NPs and PAs as they currently do with physicians. These clinicians practice as much as most physicians do and typically spend more time than most physicians counseling and educating patients, which leads to increased compliance and better outcomes.

Educationally, pharmaceutical companies should provide CME/CE support for uniquely developed NP and PA-focused programs. Until recently there have been no significant national CME/CE programs focused on these important clinicians; however, the Practicing Clinicians Exchange (PCE) was launched in 2005 as an independently produced, multi-supported symposia catering exclusively to the specific educational needs and goals of this differentiated audience. Due to an overwhelming positive response, the PCE is expanding into a more comprehensive national series which includes live and enduring educational programs for 2006 and beyond.

Within the next few years, NPs and PA s will become first-line health care professionals for our country's growing and aging population. In order to ensure a robust health care future for our nation, the pharmaceutical industry should lead the charge to recognize these increasingly important clinicians with a formalized, targeted educational initiative. If the pharmaceutical industry fails to provide the leadership needed to support this crucial educational adaptation for our evolving national health care system. then who will?


  1. Medical Economics. Terry K. Where's primary care headed? It's at a crossroads, and its future may depend on forces beyond physicians'control. Available at: http://www.memag.com/memag/article/articleDetail.jsp?id=340485. Accessed on 7.19.06.
  2. Association of American Medical Colleges. An analysis of medical school expansion plans. Available at: http://www.ama-assn.org/ama/pub/category/15327.html. Accessed on 7.19.06.
  3. Robert Graham Center. The US primary care physician workforce: persistently declining interest in primary care medical specialties. Available at: www.graham-center.org/468.xml?printxml. Accessed on 7.19.06.
  4. US Department of Labor; Bureau of Labor Statistics. Available at:www.bls.gov/oco/ocos074.htm#outlook. Accessed on 7.19.06.
  5. Tinsley R, Carl T. The prescribing impact of nurse practitioners and physician assistants grows. Inflection Point. November 2004;1-3.

Originally published in the September 2006 issue of Pharmaceutical Executive magazine. Copyright 2006 Sally Bacchetta and Robert Green, M.D. All rights reserved.

Sally Bacchetta is an award-winning freelance writer and sales trainer. She has published articles on a variety of topics, including sales training and motivation, pharmaceutical sales and emerging technologies. Read her latest articles on her freelance writer website.

Dr. Robert Green is the Managing Director of Medical Communications for The Continuing Education Alliance (CE Alliance), a consulting firm in Greenwich, CT. The CE Alliance partners with other educational providers to offer continuing medical education (CME) for physicians and physician assistants and continuing education (CE) for nurses and nurse practitioners. In addition, the CE Alliance is an accredited provider of continuing pharmacy education (CPE).