Health workforce planning: which countries include Nurse Practitioners and Physician Assistants and to what effect?

Claudia B. Maier, Ronald Batenburg, Steve Birch, Britta Zander, Robert Elliott, Reinhard Busse

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
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Background An increasing number of countries are introducing new health professions, such as Nurse Practitioners (NPs) and Physician Assistants (PAs). There is however limited evidence, on whether these new professions are included in countries’ workforce planning. Methods A cross-country comparison of workforce planning methods. Countries with NPs and/or PAs were identified, workforce planning projections reviewed and differences in outcomes were analysed, based on a review of workforce planning models and a scoping review. Data on multi-professional (physicians/NPs/PAs) vs. physician-only models were extracted and compared descriptively. Analysis of policy implications was based on policy documents and grey literature. Results Of eight countries with NPs/PAs, three (Canada, the Netherlands, United States) included these professions in their workforce planning. In Canada, NPs were partially included in Ontario’s needs-based projection, yet only as one parameter to enhance efficiency. In the United States and the Netherlands, NPs/PAs were covered as one of several scenarios. Compared with physician-only models, multi-professional models resulted in lower physician manpower projections, primarily in primary care. A weakness of the multi-professional models was the accuracy of data on substitution. Impacts on policy were limited, except for the Netherlands. Conclusions Few countries have integrated NPs/PAs into workforce planning. Yet, those with multi-professional models reveal considerable differences in projected workforce outcomes. Countries should develop several scenarios with and without NPs/PAs to inform policy.
Original languageEnglish
Pages (from-to)1085-1092
Number of pages8
JournalHealth Policy
Issue number10
Early online date11 Aug 2018
Publication statusPublished - Oct 2018

Bibliographical note

This paper emanated from two studies, the MUNROS project and the TaskShift2Nurses study. The MUNROS project ‘Health Care Reform: The iMpacton practice, oUtcomes and cost of New Roles for health profeSsionals (MUNROS), received funding from the European Union under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1), grant agreement number HEALTH-F3-2012-305467EC.

Funding for the TaskShift2Nurses study was obtained through the Harkness Fellowship in Healthcare Policies and Practice (to CB Maier) by the Commonwealth Fund and the B. Braun Foundation.

The funders had no role in the design of the study, data collection, analysis or interpretation of the data and material, nor in the write up phase of the manuscript.

We thank all those who supported and guided this work both as part of the TaskShift2Nurses study and the MUNROS research. In particular, the support by Christine Bond (MUNROS research Co-PI, University of Aberdeen) is acknowledged.


  • Workforce planning
  • Workforce projections
  • Nurse Practitioner
  • Physician Assistant
  • substitution
  • skill-mix
  • Human Resources for Health (HRH)


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