Health Practitioner Corner: Meet the Nursing Nation

By Erik Goldman | December 5, 2012

What role will a growing number of nurses and physician assistants play in administering holistic/integrative medicine?

Welcome to the nursing revolution. By the end of this decade, nurses will be on par with primary care MDs, in terms of both numbers and also importance in the delivery of basic healthcare. The ascendancy of the nursing profession, which began quietly in the 1990s, will accelerate rapidly in the next five years.

The continued roll-out of the Affordable Care Act healthcare reform plan—now assured with the re-election of President Obama—will be a major driver in pushing nurses, and to a lesser degree physician assistants (PAs), to the forefront of American healthcare.

Nutraceutical companies that want to be practitioner channel market leaders in the coming decade would do well to start making friends with the nursing nation.

A quick glance at the numbers should be sufficient to convince you. In 1991 there were roughly 31,000 nurses and physician assistants practicing in the U.S., the vast majority working in hospitals and other institutional settings, where they were largely subservient to medical doctors. By 1996, the number had doubled to 60,000.

In 2001, the number hit 122,000. Last year, the number topped 290,000, comprised of roughly 200,000 nurse practitioners (RNs and NPs) and 90,000 PAs. And the nursing revolution has only just begun. Federal government projections for the composition of the healthcare workforce in the next three years show the number of primary care physicians will remain more or less flat, rising from approximately 370,000 to 390,000 by 2015—a very small rise given the massive number of newly insured, care-hungry Americans soon to be covered under the ObamaCare plan.

The curve for nurse practitioners, on the other hand, is predicted to accelerate from 290,000 to more than 350,000 by 2015. The number of PAs is also expected to grow, though not nearly as fast, topping out at about 100,000 by 2015. Combined, there are approximately 20,000 new NP & PA graduates coming out of school each year.

The point here is that the short-fall in the primary care physician workforce—a phenomenon healthcare policy makers have seen coming for years—is going to be filled by nurses, not doctors.

With the exception of surgery, nurses and PAs can do just about everything primary care doctors do. They can legally prescribe drugs in all 50 states. Nurse practitioners can prescribe independently in all states, and they can practice entirely independently of physicians in 13 states. More states are likely to grant independent practice status to nurses in the coming years.

The old hierarchy wherein MDs were the ultimate authorities, with nurses and PAs locked into clearly subordinate roles, has been dismantled for the most part. If you stepped into a typical group practice today, and watched patient encounters from 40 feet away, you would not be able to tell the difference between the physician assistant, the nurse practitioner and the physician.

In some communities, advanced practice nurses are heading clinics, another trend that is likely to accelerate. Many other nurses are practicing in retail-based clinics in stores like Walgreens and CVS, where for many families they are the only point of contact with a licensed healthcare professional.

Even before the Obama reform plan, managed care companies had been gradually moving nurses to center-stage, viewing them as cost-effective alternatives to MDs. With their strong emphasis on relationship building and their ability to spend more time with patients, nurses have generally been well-accepted as full-scope caregivers by the American public, and their credibility has grown rapidly over the last 10 years.

None of this is lost on the pharmaceutical industry. Until recently, drug companies largely ignored nurses because they were not able to prescribe independently, and most were working under physicians. At best, they were viewed as conduits to the “real” target: MDs. That’s changing quickly, as pharmaceutical companies scramble to court this newly empowered practitioner segment.

To what extent are nurses and physician assistants interested in holistic/integrative medicine and utilizing dietary supplements, herbs and nutraceuticals? It’s an important, largely unanswered question. Equally unknown is the extent to which the nutraceutical industry has begun to reach out to these rapidly growing practitioner segments.

There are indicators that at least some nurses are taking a look at what the holistic/integrative paradigm has to offer. The Institute for Functional Medicine (IFM), one of the nation’s leading health professional educational organizations has indicated that nurses now represent the second-largest segment of new attendees at IFM’s fast-growing annual meetings.

My company definitely noticed an uptick in the number of nurses and physician assistants attending our recent “Heal Thy Practice: Transforming Patient Care” conference in Long Beach in November.

The American Holistic Nurses Association (, which formed more than 30 years ago, continues to thrive, with upward of 5,700 members across the country.

Since nurses are traditionally less “invested” in the pharmaceutical-based paradigm of medical practice, and generally thought to be more open and sensitive to patients’ needs and preferences than MDs, it makes sense that nurses would be interested in helping their patients make wise decisions about nutrition, supplementation and non-pharma treatment options. But so far, there’s no data to document the extent of this interest.

What is clear about today’s NPs and PAs is that they expect to be treated with respect—the same respect that would be accorded to a physician. They definitely do not like to be referred to in old-school terms like “physician extender” or “mid-level provider.”

This was recently pointed out to me by a nurse who attended our “Heal Thy Practice” show, and felt offended when an otherwise open-minded and well-intentioned holistic MD unconsciously referred to nurses as “mid levels” during one of the lectures.

Given their equivalent scopes of practice and their burgeoning strength, nurses want to be seen as full-scope caregivers in their own right. At the same time, they do not want to be lumped in with doctors. The long history and deep culture of nursing, as well as its training processes, are distinct from MD culture. Pharmaceutical marketing consultants stress it is very unwise to use MD-centric marketing materials with nurses, who expect marketers to recognize and honor the distinctions that make nursing a unique profession.

Dietary supplement and nutraceutical companies hoping to make inroads in the world of nursing would do well to heed these lessons.

Erik Goldman is the editor of Holistic Primary Care-News for Health & Healing, a quarterly medical news publication covering the field of holistic healthcare for an audience of roughly 65,000 primary care physicians. He is also co-founder of “Heal Thy Practice: Transforming Primary Care,” an annual conference focused on business models for integrative healthcare practices. He is currently collaborating with Greg Stephens & Windrose Partners to develop the first Health Practitioner Marketing Forum, an educational gathering on opportunities and challenges in the healthcare practitioner channel. For more information contact Erik at: 212-406-8957 or        

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