Although this year's Match Day placed more physicians in primary care residencies than last year (which itself was an improvement on 2009), the American Association of Medical Colleges estimates that the United States could still face a shortage of 45,000 primary care physicians by the end of the decade.

Thus, as states prepare for an influx of insured patients in 2014, many are following the Institute of Medicine's recommendation to remove scope-of-practice limits that prevent nurses from practicing "to the full extent of their education and training."

California is one of 23 states that allows nurse practitioners (NPs) to provide some primary care services without physician supervision. And as the state works to develop medical home models of care, as encouraged by health reform, it is setting the stage for NPs to play a lead role on these primary-care teams, the Los Angeles Times reports.

As of last month, there were about 16,000 nurse practitioners in California--a 16 percent increase from five years ago--with several clinics already having assigned patients to NPs as primary care providers.

Under the medical home model at Long Beach Comprehensive Health Center in Los Angeles, for example, Savinh Pouv, NP, is assigned about 1,000 primary care patients, and works with a medical team that includes a licensed vocational nurse, registered nurse, mental health worker and a family physician. Dr. Samuel Oregel cares for his own 1,300 patients, in addition to helping Pouv with complex cases.

According to Dr. Mitch Katz, the county's new health chief, such programs have increased preventive care, decreased patient waits and lowered healthcare costs.

Despite NPs' lower salaries--$88,000 to $128,000 vs. primary care physicians' $106,000 to $186,000--critics such as Dr. James Hay, president-elect of the California Medical Assn., contend that nurses may be more expensive than doctors because they lack doctors' training and as a result, refer more patients to specialists and order unnecessary tests.

Meanwhile, in Georgia, University Health Services at Clayton State University represents an example of a "nurse-in-a-box" operation that has been transformed into a primary care practice, director Julia Spinolo, DNP, APRN-BC, LNC, told the Atlanta Journal-Constitution, noting the clinic's massive growth since 2008. "Dr. Deborah Honeycutt [the clinic's medical director] and I used to see 10 patients a week; now we see 30 a day," Spinolo said.

But although Marcia Holstad, DSN, RN, FNP-BC, FAANP, associate professor of nursing at the Nell Hodgson Woodruff School of Nursing at Emory University, noted the vast opportunities available to today's NPs, she told the newspaper she is hopeful that health reform will help remove some of her state's current barriers to practicing as an NP.

To learn more:
- read the article in the Los Angeles Times
- see the story in the Atlanta Journal-Constitution

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