| | | | |  | | By Erin Schumaker, Carmen Paun, Daniel Payne and Evan Peng | | | | | 
Your primary care provider is more likely to be a nurse than it used to be. | Christopher Furlong/Getty Images | | | "Even that phrase, 'Oh, should I go see my doctor?' is kind of out of touch with what the reality is."
Dr. Ateev Mehrotra, professor of health care policy and medicine at Harvard Medical School | | Going to the doctor used to mean an office visit with a white coat who'd earned a medical degree. That’s changing. Today, at least a quarter of health care visits are performed by a nurse practitioner or physician assistant, new research in BMJ says. The research team used Medicare claims data to quantify visits with nurse practitioners and physician assistants, including those billed as physician visits when a nurse practitioner or physician assistant provided most or all of the care. By the numbers: — The proportion of traditional health care visits by nurse practitioners and physician assistants grew from 14 percent to 26 percent between 2013 and 2019. That shift likely accelerated during the pandemic. — Among patients who had one or more visits in 2019, 42 percent saw a nurse practitioner or physician assistant at least once. — Nurse practitioners and physician assistants were more likely to see patients for things like respiratory infections (42 percent) and anxiety (37 percent) than for other conditions, like heart disease (18 percent) or eye disorders (13 percent). — The likelihood of seeing a physician assistant or nurse practitioner was higher for patients with disabilities, as well as low-income and rural patients. Driving the trend: More physician assistants and nurse practitioners are entering the workforce than primary care doctors. The Bureau of Labor Statistics projects that the number of nurse practitioners will grow from 200,000 to 359,000 from 2019 to 2031. The number of physician assistants is estimated to grow from 120,000 to 178,000. As the U.S. population increases and Americans age, medical schools aren’t producing enough doctors to meet the need. According to the Association of American Medical Colleges, the U.S. could face a shortage of up to 48,000 primary care doctors by 2034. Even so: It's not a cage-match, with nurse practitioners in one corner and doctors in the other, competing over who's going to provide better care, Dr. Ateev Mehrotra, coauthor of the study and professor of health care policy and medicine at Harvard Medical School, told Erin. "It's not like this one-to-one replacement. Rather those two clinicians are working side-by-side in teams," he said. Nurse practitioners may be addressing less severe illnesses, the study notes, while doctors handle visits where their training is most needed. Mehrotra says his study aims to quantify the trend, not to worry people about it: "It's happening, but is it leading to worse or better care? I don't know of any evidence to raise concern for the public."
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Gasa, Yunnan, China | Evan Peng | This is where we explore the ideas and innovators shaping health care. Kids do learn some useful things on screens, it turns out. Case in point: a 12-year-old boy saved a drowning man by performing CPR he learned watching "Stranger Things". Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Evan Peng at epeng@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Katherine Ellen Foley talks with health care reporter Alice Miranda Ollstein about the key takeaways from POLITICO’s “Transforming Health Care: Site-Neutral Payments & Billing Transparency” live event.
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Policymakers are worried about smartphone addiction, but efforts to intervene face First Amendment concerns. | Getty Images | Legislation aimed at protecting kids online — including from content that could negatively affect their health — has a First Amendment problem. That was the finding of California federal district court Judge Beth Labson Freeman in San Francisco this week. Freeman halted implementation of a state law that would require tech platforms like Facebook and YouTube starting next July to limit risks their products pose to children’s health and safety, POLITICO’s Rebecca Kern reports. Labson granted a preliminary injunction on behalf of the tech industry trade group NetChoice while the court further considers the merits of the case. Why it matters: An array of studies have found that many kids have become addicted to social media and that the more they use it, the more they are likely to experience anxiety, depression and other mental health ills. Even so: Labson’s decision follows a similar one in Arkansas, where a federal judge found that Arkansas’ parental consent online safety law likely violated the First Amendment, and stopped the law from taking effect. NetChoice was the plaintiff. The state losses could preview potential constitutional challenges for the bipartisan group of senators looking to pass similar legislation — known as the Kids Online Safety Act — in Congress. The Senate Commerce Committee approved that bill in July.
| | | | HAPPENING 9/28 — INSIDE THE CANCER MOONSHOT: Join POLITICO on Thursday, Sept. 28 for an in-depth discussion on the future of cancer treatment and innovation. Hear from experts including scientists, government officials and industry leaders as we explore the critical roles played by private industry, nonprofits, the National Cancer Institute and the new Advanced Research Projects Agency for Health in achieving the Biden administration's goal of cutting the cancer death rate in half over the next 25 years. Don't miss this opportunity to dive into the progress of cancer treatments and learn about the challenges patients encounter in accessing care. REGISTER HERE. | | | | | | | | |  The number of people under treatment for tuberculosis now exceeds pre-pandemic levels. | AP | Efforts to combat HIV, tuberculosis and malaria bounced back in 2022 after two years of disruptions caused by the pandemic. Here’s the good news: The Global Fund to Fight HIV, Tuberculosis and Malaria, of which the U.S. is the largest donor, said more people with HIV and TB began treatment than ever last year and that it distributed a record number of bed nets to help prevent the mosquito bites that cause malaria. The recovery in TB treatment was particularly strong, Peter Sands, the fund’s executive director, told Carmen. “The fact that we're now at record levels of diagnosing and treating people, some 6.7 million people in 2022, which is a lot higher than the 5.8 [million] in 2019 before the pandemic, is remarkable,” he said, noting that governments and civil society programs should get a lot of credit. And the bad: The world is facing ongoing and new crises, from climate change to conflicts, which lead to more people dying from infectious diseases, Sands said. “We’re seeing it already in places like Sudan: the inability of people to access services means that people who get diseases are more likely to die,” Sands said, referring to a civil war that started in April. More than 1,200 refugee children under 5 in Sudan’s White Nile state have died since May due to a likely measles outbreak and malnutrition, according to the World Health Organization and UNICEF. Children are also the victims of climate change, which is leading to extreme weather events such as floods, making it easier for malaria to spread, according to Sands. “If the world wants an equitable response to the impact of climate change, one of the most concrete things we could do is get rid of malaria,” he said. | | | | Follow us on Twitter | | | | Follow us | | | | |
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