Message to Marketers: The Physician’s Assistant (or Nurse Practitioner) Is in

The spiraling growth and importance of physicians’ assistants and nurse practitioners in the U.S. health sector is making them a ripe audience for pharmaceutical marketing.

The physicians’ assistants (PAs) and nurse practitioners (NPs) fields began developing in the mid-1960s in response to a perceived shortage of physicians, particularly in underserved rural areas. And while PAs and NPs still play a critical role in providing rural healthcare, today they are just as likely to be found in urban and suburban settings serving as adjuncts to busy physicians. In fact, PAs and NPs are the leading allied health professionals in the U.S. As of the beginning of this year, there were 64,500 PAs and 132,500 NPs.

Rigorous Training, Prescribing Authority

It’s not just sheer numbers but a fairly sophisticated level of medical training (and the prescribing authority that provides) that make PAs and NPs an appealing and potentially lucrative target for pharmaceutical advertising. Training for PAs, for example, usually requires 1,000 classroom hours and 2,000 clinical hours. Programs are affiliated with medical schools, focused on disease pathology and treatment — an approach very similar to the way physicians are trained. Virtually all PAs receive their original training around a primary care model, and many later go on to pursue a particular specialty when this is complete.

Of greater significance to marketers, PAs had prescribing authority in 48 states as of 2005. While they must work under the supervision of physicians who set the policies, in daily practice PAs are able to write prescriptions without oversight. Most states restrict PAs from prescribing controlled substances or require that they obtain additional licensing to do so. But with the exception of controlled substances, PAs can prescribe virtually any category of drug.

NP educational requirements are generally a little lighter. On average, NPs are required to complete 500 classroom hours and 600 clinical hours. Their programs are usually affiliated with nursing schools, with an emphasis on wellness, health promotion and disease prevention. NPs are trained in a nursing model and generally steered toward positions in adult, pediatric, women’s or geriatric care.

Although there are innumerable exceptions, one could say that the role of an NPs is to see patients in addition toa physician, while the role of the PA is often to see patients in lieu of having a physician see them. Still, NPs had prescribing authority in 42 states as of 2005, and like PAs, they can prescribe most non-controlled substances. The requirements for physician supervision for NPs are slightly higher than for PAs, but on a day-to-day basis they still have significant prescribing authority.

While the training requirements for these auxiliary professionals is nowhere near that of physicians (who, on average, spend more than 4,000 hours in the classroom alone), it doesn’t have to be. The majority of patients they see have common conditions that lend themselves to fairly established treatments, and physicians are available to attend to more complicated cases. As it turns out, the common conditions that PAs and NPs treat are also the ones that provide the basis for most blockbuster drugs.

Promising Marketing Target

As shown in the table below, PAs and NPs collectively accounted for 340.3 million prescriptions in 2006, representing a little more than 10 percent of all prescriptions written in the U.S. On an absolute basis, NPs generate a larger number of prescriptions: 203.7 million, or 6.1 percent of the U.S. total, versus 136.6 million, or 4.1 percent of the U.S. total, for PAs. However, considering that the PA universe is a little under half the size of the NP universe, it is clear that PAs are the more productive group, writing an average of 2,100 prescriptions each, 37 percent more than the 1,500 prescriptions written by each NP.

Unsurprisingly, all this activity hasn’t gone unnoticed by pharmaceutical companies. In the next issue of PDMSN we will examine the potential of PAs and NPs as a marketing target compared with physician audiences. We’ll also look at which therapeutic categories receive the highest portion of prescriptions from these allied health professionals, and we’ll see what pharmaceutical marketers are doing to fit these target audiences into the overall promotional picture. — Todd Clark