As the supply of physicians in Louisiana and across the nation fails to keep up with patient demand, nurses are working to fill the gap.
As the gap between physician availability and demand widens, patients end up having to wait longer to see a doctor and physicians suffer from burnout.
According to the Cicero Institute, the U.S. is projected to have a physician shortage of 120,000 by 2035, with Louisiana expected to have a shortage of 4,820 physicians. Louisiana already ranks in the bottom half of states in primary care and physician supply.
In Louisiana, there are more than 3,500 patients for every health care worker, and 60 of the state’s 64 parishes are considered health care worker shortage areas.
The supply of new doctors is also poor, and a physician shortage is predicted: Louisiana only has 313 spots available for primary care residency training each year, and half of those residents end up practicing outside the state, according to the institute.
Nurses play a key role in filling gaps in care created by health care worker shortages.
“The nurses are a great asset,” said Trevis Badeau of Our Lady of Lourdes Regional Medical Center in Lafayette.
Nurse practitioners can provide many of the same services as primary care physicians, with a few exceptions. Nurse practitioners focus on preventive care, such as annual physicals, mammograms, lung cancer screenings, testing for high cholesterol and diabetes, and disease consultations.
“If there’s something that’s outside of our scope of practice, we’ll refer them to a specialist if necessary,” said Ashley Begneault, a Lourdes nurse practitioner with a practice in Breaux Bridge.
Hayes and other nurses also work with doctors to review treatment plans and overall patient care.
Nurses can prescribe most medications, just like doctors, but some services, such as chronic pain management with narcotics and weight loss treatment with controlled substances, are outside their scope of practice.
If these services are needed, the nurse may refer the patient to a specialist or their family doctor.
The presence of nurses to supplement the ranks of local primary care providers is especially beneficial for low-income patients who are most affected by provider shortages.
Hayes said she has seen this challenge among her patients, many of whom had trouble finding a provider before coming to her clinic.
“Medicaid patients have a hard time finding a primary care doctor, and when they come to me, it’s hard to get a referral to a specialist,” Begneault said.
Louisiana’s Medicaid reimbursement rates are comparable to the national average, but doctors generally lose money the more Medicaid patients they treat compared to privately insured doctors who offer higher reimbursement rates.
As a result, people on Medicaid overall have “limited access to health care, and that’s unfair to them, because they need health care just like anyone else,” Begneault said.
The shortage of primary care physicians is especially acute in rural parishes.
“In our more rural areas, nurse practitioners are the only providers of medical and mental health services,” said Roger Istres, chief operating officer for Iberia Integrated Community Health Centers, which runs several clinics in rural Acadiana and Central Louisiana.
“Without NPs, we would not be able to provide care to patients in these areas, and depending on their ability to travel, without NPs they may not be able to get the care they need,” Istre said.
While rural and low-income residents will benefit the most, having more local providers will benefit all patients, making it easier to access care where they live.
“Our main focus has always been to treat patients here in Acadiana and get them as close to home as possible,” Badeau said, “so they can get care from their neighbors, their friends, the people they go to church with.”
She added: “Having family and friends to accompany you through your health care journey can make a big impact on your care.”
