< Back to e-newsletter    Next article >

Demand Increases for Mid-levels in Subspecialty Medicine

Mid-level providers, specifically Nurse Practitioners and Physician Assistants, have long been regarded as key players in the delivery of primary care. As a cost-effective means to mitigate the impending work force shortage, the role of mid-levels is expanding with more and more working in specialty specific areas.

In 1996, the distribution of mid-levels in primary care was 50%. Recent studies show a significant decrease in mid-levels focusing on primary care, down to 38%. The remaining 62% practice in over 60 different subspecialty fields including 26% practicing in a surgical subspecialty, 25% in Emergency Medicine, 22% in various subspecialties of Internal Medicine and 4% in Dermatology.

Additionally, the demand for specialized mid-levels will continue to grow as newly trained residents and fellows enter practice. New physicians are training in technically demanding specialties and learning in a team environment which includes Physician Assistants and Nurse Practitioners. Naturally, they expect mid-levels to be a part of their teams in the future.

Seeking to address this increasing demand, Physician Assistant and Nurse Practitioner training programs continue to enhance their curricula and have expanded postgraduate training to include various medical and surgical subspecialties. Additionally, both Physician Assistant and Nurse Practitioner associations have efforts under way to credential/certify mid-levels in a variety of specialty areas.

A review of current job postings shows the greatest demand for mid-levels to be in the area of surgical subspecialties including Orthopaedics, Plastic Surgery, Neurosurgery and Cardiothoracic Surgery. Internal Medicine subspecialties show the second greatest demand, including Cardiology, Rheumatology, Endocrinology, Hematology/Oncology and Gastroenterology. Other noted areas of need are Emergency Medicine and Dermatology.

Effective use of a mid-level in specialty practices has proven to increase revenue, improve patient satisfaction and make the overall working environment more productive and satisfactory. Various resources are available to educate practice managers and administrators on effective utilization of mid-levels in specialty settings. For more information about these resources, please contact us.