Nurse practitioners are taking on more patient care responsibilities in hospitals, helping organizations address growing care demands amid the national physician shortage. However, education gaps may leave many NPs unprepared for practice, posing potential patient safety risks, Bloomberg Businessweek reported Nov. 22.
The report is the second installment in Bloomberg's series exploring the growing role of NPs in today's healthcare system. Its first report, published in July, alleged that many NP programs lack standardized curricula and sufficient clinical training. The latest installment explores the potential safety ramifications for health systems that are overly reliant on NPs who may be unprepared to step into high-stakes roles immediately after graduation.
Four report takeaways:
1. Health systems are increasingly assigning NPs to roles with greater independence, driven in part by physician shortages and the need for cost-effective staffing. NPs are twice as profitable for hospitals to employ, according to 2022 data from Kaufman Hall. A primary care NP costs significantly less to employ than a primary care physician — $156,546 versus $344,308 annually — while generating nearly the same revenue ($424,979 for NPs vs. $462,000 for physicians).
Matthew Bates, a managing director at Kaufman Hall, predicts advanced practice providers will outnumber physicians within the next decade. "It can either be a cause of success and economic benefit or it can cause a lot of disruption, depending on how you handle it," he said in a 2023 podcast cited by Bloomberg.
2. In today's healthcare industry, comprehensive NP training programs in hospitals are relatively rare, partly because federal funding is only allocated for physician training. As a result, the level of preparation NPs receive to work in high-stakes environments like intensive care units is "unbelievably variable," according to Craig Coopersmith, MD, director of the critical care center at Atlanta-based Emory University Hospital. Dr. Coopersmith advocates for increasing federal funding for residency programs and expanding this support to all clinicians.
"You clearly have people who literally aren't trained to do what they’re doing,” he told Bloomberg. "There are ways to prevent that."
3. Many large health systems are using NPs to scale services efficiently and reduce staffing costs. This shift is driven by the need to address workforce shortages and improve operational efficiency, with NPs filling critical roles across various specialties. Nashville, Tenn.-based HCA Healthcare staffs about 37 NPs for every 100 physicians, slightly above the industry average, according to Bloomberg's review of HHS data. The company also has one of the lowest ratios of physicians and APPs per bed among more than 600 health systems tracked by HHS. While this approach has allowed HCA to achieve significant financial efficiency, it has also raised concerns about the high pressure placed on NPs who may be tasked with managing high-stakes patient care beyond their level of training. The publication cited the case of an early-career nurse practitioner who was terminated by HCA in April 2022 after four patients reportedly died under her care.
HCA defended its staffing practices and criticized Bloomberg's analysis in a Nov. 22 statement to Becker's. The health system alleges that the analysis underestimates the number of physicians working in its hospitals by two-thirds, as the HHS data only includes physicians who are "closely affiliated" with systems. In total, more than 45,000 physicians have medical privileges at HCA hospitals.
"We, like hospitals across the country, use NPs to supplement, not replace, physician-led care teams in hospitals," the HCA spokesperson said. "Our use of properly trained and licensed NPs is appropriate; they are supervised by physicians who are available for consultation. It is unfortunate that Bloomberg would publish a story that ignores data we provided and prioritizes unfounded allegations over state findings."
4. For health systems, the key challenge is how to expand reliance on NPs and other APPs while minimizing safety risks. Emory University Hospital is using a creative staffing model to address this concern. The Emory Critical Care Center employs 200 advanced practice providers and 88 physicians who sit in a centralized virtual command center. In this model, APPs are the backbone of intensive care, while physicians manage the overall flow of care. Emory credits the program's success to an extensive transition-to-practice program for NPs. The system is also the first in the nation to offer a yearlong fellowship for APPs.
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