Talbot McCormick

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The shortfall of primary care physicians is nothing new. Hospitals struggle daily with staffing issues—particularly rural hospitals, where the supply of hospitalists (physicians who specialize in practicing in the hospital setting rather than in private practice) and specialists has traditionally been slim.

 news is how nurse practitioners (NPs) and physician assistants (PAs) are filling the gaps—with support from telemedicine.

Let’s start with some statistics. In updated 

 released this year, the American Association of Medical Colleges (AAMC) estimates that by 2030, the demand for physicians will exceed supply by 40,800 to 104,900. Why such a wide range? The AAMC notes that a major contributing factor to the lower estimate would be the rapid growth in non-physician clinicians, such as NPs and PAs, performing tasks that physicians traditionally perform.

 show there were about 155,000 practicing NPs in the United States in 2010. That number will grow by 57 percent to 244,000 in 2025. The PA supply will grow by about 73 percent during the same period, from 74,000 to 128,000.

Smart hospital leaders are already taking advantage of the more plentiful supply of NPs and PAs. While they still employ hospitalists to lead the clinical team, they are rounding out their staffs with NPs and PAs who perform many of the same functions as physicians. They conduct daily rounds, admit people from the emergency department (ED) to the floor, diagnose patients, and prescribe treatment and medication.

And because the onsite hospitalists can’t be everywhere at once, many hospitals rely on telemedicine to back up the NPs and PAs on the team. Through telemedicine, a cadre of hospitalists and other specialists in remote locations is available by phone, text, and 2-way video-conferencing to advise the local clinical team, suggest approaches to patient care, and validate decisions the NPs and PAs make. The telehospitalists might be in the same state and time zone; they might be across the country or, in some instances, halfway around the world. However, they must be licensed in the state and credentialed by the facility at which they are practicing. Wherever they are, response time is fast.

In site after site where this combination is deployed, we see it working well. As one NP at a rural hospital in Kansas said about the support she gets from telehospitalists: “I couldn’t do what I do without them.”

Anthony Medical Center (AMC) is a 25-bed critical access hospital in Anthony, Kansas, about 60 miles west of Wichita. For 3 years, telemedicine has provided backup support for 3 PAs and 1 NP who staff the inpatient facility, the ED, and the hospital’s attached rural health clinic.

All of them view the telemedicine program as an essential part of the healthcare team at AMC.

Before the telemedicine program was implemented, AMC had contacts with several inpatient specialists in Wichita who would provide NPs and PAs with expert opinions when needed. But when the telemedicine program began and its inpatient specialists became immediately available to the team, the backup process became more structured, comprehensive, consistent, and effective.

“When telemedicine came on board, we could discuss each of our patients with the telehospitalists and look at our patients from a broader perspective,” said Rebecca Carter, an advanced registered NP at the facility. “We transfer fewer patients because we make more confident decisions that patients can stay here with our own resources and get the level of care they require.”

Carter finds the telemedicine program invaluable to her professional growth and developing the skills she needs at AMC. She tells the story of a young patient who had overdosed and was brought to the ED in cardiac arrest. “While we were providing resuscitation for the patient, I discussed the patient’s condition and considered all potential causes with one of the telehospitalists. We did have to fly the patient out, but he is alive today. I believe we had that outcome because we were working in conjunction with telemedicine on a very complicated clinical case.”

A Range of Opportunities for Telemedicine

There are many good ways to apply telemedicine in the inpatient setting, whether it’s a traditional acute care facility, a micro-hospital, a long-term acute care hospital, or a critical access hospital like the one in Kansas. Telemedicine helps solve night-coverage challenges, provides quick access to a range of specialties, and aids local physicians in avoiding burnout. And as a way to bring NPs and PAs into positions of greater responsibility at a time when physicians are growing scarce, it’s proving to be a vital resource.

Talbot “Mac” McCormick is president and CEO of Eagle Telemedicine, a 10-year pioneer in telemedicine processes and strategies. Dr. Mac became a hospitalist in 2003 after practicing internal medicine for 20 years, and quickly saw the opportunities telemedicine offered as a solution to many hospital challenges. Contact him at Mac.Mccormick@eglhp.com.

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