EMSI’s New Data: U.S. Schools Are Training More Nurse Practitioners, But Is it Enough?

INSIDE THE NEW OCCUPATIONS IN ANALYST

Last week we introduced the 30 or so new occupations that the Bureau of Labor Statistics now tracks and EMSI provides data for in Analyst and our other tools. This post is part of a series digging into the new occupations — and our new numbers — more closely.

This summer The New York Times and Wall Street Journal, along with a host of health-related journals and news sites, have debated a critical question in health workforce circles: With the current shortfall of primary care physicians expected to worsen, can nurse practitioners step in to treat patients?

It’s a contentious issue — just read Dr. Pauline Chen’s account in the Times — but most agree nurse practitioners will increasingly be in demand as healthcare reform continues to take effect. Which raises another question: Are there enough new NPs streaming into the workforce to satisfy clinics, doctor’s offices, and the rest?

As part of the Bureau of Labor Statistics’ 2010 Standard Occupational Classification system update, EMSI now has comprehensive and regional data on nurse practitioners and two other nurse specialties — nurse anesthetists and nurse midwives — in addition to registered nurses and other healthcare fields. This means our users can analyze the nurse practitioner workforce in their area and see NP-related degrees that local educational institutions are producing on a year-to-year basis.

SOC	Description	2010 Jobs	2013 Jobs	Change	% Change	Estimated Annual Openings (2013)	Median Hourly Earnings
Source: QCEW Employees, Non-QCEW Employees & Self-Employed - EMSI 2013.3 Class of Worker
29-1141	Registered Nurses	2,599,468	2,727,171	127,703	5%	125,770	$32.04
29-1171	Nurse Practitioners	102,713	110,545	7,832	8%	6,093	$43.77
29-1151	Nurse Anesthetists	33,169	36,179	3,010	9%	2,018	$72.20
29-1161	Nurse Midwives	5,583	6,090	507	9%	340	$42.83
	Total	2,740,934	2,879,984	139,050	5%	134,221	$32.38

Nurse practitioners, using Chen’s definition, are nurses who have completed graduate-level studies and up to 700 additional hours of supervised clinical work. There aren’t always clear associations between classified educational programs from the National Center for Eduction Statistics (NCES) and advanced or specialized fields like nurse practitioner. (Many NPs, it should be noted, complete specific certifications based on the field they’re going into.)

This summary from the American Association of Colleges of Nursing gives a rundown of enrollment and graduations (Aug. 1, 2011 to July 31, 2012) for nurse practitioners, showing 12,789 completions nationwide. That matches pretty closely with the six programs we highlighted in the chart. Just over 13,000 degrees were awarded in these six programs in 2012, up from less than 4,000 in 2003 and 8,500 in 2010. In the family practice nurse/nursing program — which perhaps most closely relates to nurse practitioners, especially ones seeking to get into primary care — degree output has increased fivefold nationwide since 2003 (see the dark red line in the chart).

In the family practice nurse/nursing program — which perhaps most closely relates to nurse practitioners, especially ones seeking to get into primary care — degree output has increased fivefold nationwide since 2003.

It’s important to note that not all these graduates will become nurse practitioners. Some could become advanced registered nurses; others (especially graduates of nursing science) could become postsecondary nursing instructors. Nonetheless, EMSI’s education data shows a sharp spike in NP-related degrees from U.S. institutions — similar, in fact, to the spike we’ve written about for registered nursing, now the third-largest degree-conferring program in the US (at 193,528 degrees in 2012).

The RAND Corporation’s David Auerbach, one of the nation’s nursing workforce experts, projects there will be between 198,000 and 244,000 nurse practitioners (depending on how they are identified and reported) by 2025. That’s a huge increase from 2008, the first year of his analysis, and even a major increase from the current job numbers. But if Auerbach’s projection is anywhere close to accurate, the number of NP-related degrees that U.S. institutions have produced in recent years, while increasing, won’t be enough.

Where Are Existing Nurse Practitioners Concentrated?

The above map shows the percentage job growth/decline for nurse practitioners from 2010-2013 for metropolitan statistical areas in the U.S. There’s plenty of decline in the MSAs, as the red indicates, but nationally, the nurse practitioner workforce has grown 8% since the start of 2010.

With EMSI’s new data, we can also look at where the existing NP workforce is most concentrated in the U.S, using location quotient. Twenty-five MSAs are at least twice as as concentrated as the national average (1.00). Rochester, Minn., where the Mayo Clinic is located, easily has the most concentrated nurse practitioner workforce in the nation; it’s almost eight times more concentrated than the national average — and more than four times as concentrated the second-ranked MSA, Meridian, Miss.

Tennessee metros such as Chattanooga, Knoxville, and Johnson City are also well represented. And while Nashville didn’t make the top 25, it is close with a concentration of 1.94. As we noted in our first post, Tennessee has the highest concentration of NPs among all states and Washington, D.C.

Note: For the following table, we only included MSAs that have 100 or more estimated nurse practitioner jobs in 2013.

Metropolitan Statistical Area	2013 Nurse Practitioner Concentration (Natl. Avg.=1.00)
Source: QCEW Employees, Non-QCEW Employees & Self-Employed - EMSI 2013.3 Class of Worker
Rochester, MN (40340)	7.98
Meridian, MS (32940)	3.75
Cape Girardeau-Jackson, MO-IL (16020)	3.64
Marshfield-Wisconsin Rapids, WI (32270)	3.05
Provo-Orem, UT (39340)	3.04
Morgantown, WV (34060)	3.02
Hattiesburg, MS (25620)	2.96
Johnson City, TN (27740)	2.61
Duluth, MN-WI (20260)	2.58
St. George, UT (41100)	2.56
Ithaca, NY (27060)	2.43
Bangor, ME (12620)	2.34
Chattanooga, TN-GA (16860)	2.31
Lebanon, NH-VT (30100)	2.26
Fargo, ND-MN (22020)	2.25
Winchester, VA-WV (49020)	2.24
Gulfport-Biloxi, MS (25060)	2.23
Knoxville, TN (28940)	2.16
Durham-Chapel Hill, NC (20500)	2.16
Chico, CA (17020)	2.16
Rochester, NY (40380)	2.15
Gainesville, FL (23540)	2.09
Tupelo, MS (46180)	2.06
Utica-Rome, NY (46540)	2.06
Sioux Falls, SD (43620)	2.05

Users can access this information by logging in to Analyst (you’ll automatically be updated to the 2013.3 dataset). For more information on Analyst or EMSI data, email Rob Sentz or visit our Analyst and Data pages.