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A Presentation of the Colorado Health Institute

Rural APNs & PAs in Colorado: Results from CHI’s 2010 – 2011 Workforce Surveys

Jacqueline L. Colby, PhD, MPH

Colorado Rural Health ConferenceAugust 11th, 2011

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APNs: All KindsNurse Practitioners

(NPs)

Certified Registered Nurse Anesthetists

(CRNAs)

Certified Nurse Midwives (CNMs)

Clinical Nurse Specialists (CNSs)

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Plus PAs

Primary CarePAs (57%)

Specialty Care PAs (43%)

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How many are in rural areas?

PAs

NPs

CRNAs

CNMs

CNSs

0 400

800

1,20

0

1,60

0

2,00

0

11% prac-tice in rural

areas

11%

21%

5%

7%

Rural Urban

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Distribution of NPs & Physicians

Counties with at least one registered NP and no practicing primary care physician

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Distribution of PAs

Counties with at least one practicing PA and no practicing primary care physician

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Distribution of CRNAs & Anesthesiologists

Counties with at least one registered CRNA and no practicing anesthesiologist

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Distribution of CNMs & OB-GYNs

Counties with at least one registered CNM and no practicing Ob-Gyn

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Rural APNs: Heavy lifters

In primary care

In primary care w/women's health

Spend majority of time in direct care

Work full-time

Of registered, work as Colo. APNs

82%

95%

75%

76%

100%

69%

CRNAs NPs

N/A

N/A

N/A

N/A

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Rural PAs: Carrying their share

Average time spent in direct care

Rural PAs fluent in Spanish

Rural PAs delivering primary care

Licensed, rural PAs working FT

Licensed, rural PAs working

70%

28%

57%

84%

99%

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Rural NPs who reported growing up in a rural area

Rural PAs and 65% of rural PAs in primary care who reported growing up in a rural area

52% Rural NPs who support increased access to loan forgiveness programs

PAs who support increased access to loan forgiveness programs

57%

Grow your own? Loan forgiveness?

58%

74%

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NP & PA Retention factors

Aged 55+

Very satisfied with career

Very satisfied with compensation

Earn $70,000+ (full-time)

Planning to leave position in next year

42%

78%

36%

58%

25%

47%

91%

74%

100%

3%

18%

80%

49%

82%

13%

PAs Rural CRNAs Rural NPs

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Aged 55+

Very satisfied with career

Very satisfied with compensation

Earn $70,000+ (full-time)

Planning to leave position in next year

25%

PAs Rural CRNAs Rural NPs

NP & PA Retention factors

• lack of respect• family responsibilities • insufficient wages

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NP Work settings

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Practice privileges available to NPs

Rx authority

NPI number

DEA number

80%

95%

87%

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NP hurdles to providing quality care

Patient ability to afford access to needed care

84%Receiving timely reports

76%Availability of qualified specialists

63%

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Medicare

Medicaid adults

Medicaid children

CHP+ children

CHP+ pregnant women

16%

18%

22%

22%

54%

8%

16%

19%

20%

30%

Percent of Rural practices not accepting new patients, by insurance type

PAs NPs

All insurance was not created equal

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Summary of APN survey findings• Important providers of primary &

anesthesia care• Upcoming retirement wave• Prescriptive authority not universal• Patients unable to afford needed care– Insurance doesn’t guarantee access

either

• Availability of specialists limits quality of care

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Summary of PA survey findings• Rural PAs are important providers of primary care.• Retirements expected to be lower than NPs, as the

former tend to be younger.• PAs’ scope of practice is based on a physician’s

delegation of duties and often includes prescriptive authority.

• Rural practices with PAs were slightly more likely than rural practices with NPs to accept Medicaid and CHP+ patients.

• PAs in rural practices were more likely to accept Medicaid, Medicare and CHP+ patients than their urban counterparts.

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Thank You

For comments and answers to questions contact:

Jacqueline L. Colby, PhD, MPHProgram Manager, Center for the Study of the Health Professions Workforce720.382.7095colbyj@ColoradoHealthInstitute.org

Athena Dodd, MSPHResearch Analyst, Center for the Study of the Health Professions Workforce720.382.7093dodda@ColoradoHealthInstitute.org