Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
School of Health Studies, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands.
BMC Health Serv Res. 2023 Jun 6;23(1):580. doi: 10.1186/s12913-023-09568-4.
Many countries are looking for ways to increase nurse practitioner (NP) and physician assistant/associate (PA) deployment. Countries are seeking to tackle the pressing issues of increasing healthcare demand, healthcare costs, and medical doctor shortages. This article provides insights into the potential impact of various policy measures on NP/PA workforce development in the Netherlands.
We applied a multimethod approach study using three methods: 1) a review of government policies, 2) surveys on NP/PA workforce characteristics, and 3) surveys on intake in NP/PA training programs.
Until 2012, the annual intake into NP and PA training programs was comparable to the number of subsidized training places. In 2012, a 131% increase in intake coincided with extending the legal scope of practice of NPs and PAs and substantially increasing subsidized NP/PA training places. However, in 2013, the intake of NP and PA trainees decreased by 23% and 24%, respectively. The intake decreased in hospitals, (nursing) home care, and mental healthcare, coinciding with fiscal austerity in these sectors. We found that other policies, such as legal acknowledgment, reimbursement, and funding platforms and research, do not consistently coincide with NP/PA training and employment trends. The ratios of NPs and PAs to medical doctors increased substantially in all healthcare sectors from 3.5 and 1.0 per 100 full-time equivalents in medical doctors in 2012 to 11.0 and 3.9 in 2022, respectively. For NPs, the ratios vary between 2.5 per 100 full-time equivalents in medical doctors in primary care and 41.9 in mental healthcare. PA-medical doctor ratios range from 1.6 per 100 full-time equivalents in medical doctors in primary care to 5.8 in hospital care.
This study reveals that specific policies coincided with NP and PA workforce growth. Sudden and severe fiscal austerity coincided with declining NP/PA training intake. Furthermore, governmental training subsidies coincided and were likely associated with NP/PA workforce growth. Other policy measures did not consistently coincide with trends in intake in NP/PA training or employment. The role of extending the scope of practice remains to be determined. The skill mix is shifting toward an increasing share of medical care provided by NPs and PAs in all healthcare sectors.
许多国家都在寻找增加护士从业者（NP）和医师助理/助理（PA）部署的方法。各国都在寻求解决医疗需求不断增加、医疗成本上升和医生短缺等紧迫问题。本文提供了对荷兰各种政策措施对 NP/PA 劳动力发展潜在影响的见解。
我们使用三种方法应用了一种多方法研究：1）对政府政策的审查，2）对 NP/PA 劳动力特征的调查，以及 3）对 NP/PA 培训计划入学人数的调查。
直到 2012 年，每年进入 NP 和 PA 培训计划的人数与补贴培训名额相当。2012 年，入学人数增加了 131%，恰逢扩大 NPs 和 PAs 的执业范围，并大幅增加补贴的 NP/PA 培训名额。然而，2013 年，NP 和 PA 学员的入学人数分别减少了 23%和 24%。医院、（护理）养老院和精神保健领域的入学人数减少，恰逢这些部门的财政紧缩。我们发现，其他政策，如法律承认、报销和资金平台以及研究，并不始终与 NP/PA 培训和就业趋势一致。从 2012 年每 100 个全职等效医生中有 3.5 个和 1.0 个 NPs 和 PAs，到 2022 年，所有医疗保健部门的 NPs 和 PAs 与医生的比例分别大幅增加到 11.0 和 3.9。对于 NPs，在初级保健中，每 100 个全职等效医生中有 2.5 个，而在精神保健中则有 41.9 个。PA-医生比例从初级保健中每 100 个全职等效医生中有 1.6 个到医院护理中有 5.8 个。
本研究表明，具体政策与 NP 和 PA 劳动力增长相一致。突然而严重的财政紧缩恰逢 NP/PA 培训入学人数下降。此外，政府培训补贴与 NP/PA 劳动力增长相吻合，可能与之相关。其他政策措施与 NP/PA 培训或就业人数的趋势并不始终一致。扩大执业范围的作用仍有待确定。技能组合正在向所有医疗保健部门由 NPs 和 PAs 提供的医疗服务份额增加转变。
