From the Supreme Court's decision to uphold the Patient Protection and Affordable Care Act to the consolidation of the American Academy of Nurse Practitioners and the American College of Nurse Practitioners, nurse practitioners and physician assistants saw favorable changes that have paved the way for a bright 2013.

As CNN Money reported in its annual "Best Jobs in America" report, NPs and PAs are in high demand. Physician assistants, ranked as the 16th best job in the report, have a projected 30% growth rate over the next 10 years.

Nurse practitioners, ranked (strangely) as the 52nd best job, will have a 19% growth rate over the next decade, according to the report (view it at http://money.cnn.com/pf/best-jobs/2012/snapshots/index.html).

Tricia Patee, director of product management for HealtheCareers Network, a national job board and recruiting firm, said that NPs and PAs will fill a void in basic healthcare needs this year.

In 2012, physician assistants were most often employed in general practice, orthopedics, emergency and family medicine and experienced a 48% increase in job openings over 2011, HealtheCareers reported.

Nurse practitioners flourished in general and family practice, and psychiatric, adult and emergency medicine, with a 128% increase in available jobs last year. As more Americans obtain health insurance under the Patient Protection and Affordable Care Act, experts predict that the job openings for nurse practitioners and physician assistants will expand further.

Healthcare Reform

Last year, the world watched as the United States Supreme Court upheld the basic tenets of the Patient Protection and Affordable Care Act, changing the face of healthcare.

Although the presidential and congressional elections raised the issue of repeal, the reelection of President Barack Obama and the overall mild effects on the political makeup of Congress serve to secure the act and its broadest provisions.

For nurse practitioners and physician assistants, the prospects for employment as a result of the PPACA will be broadened. With the projected influx of 34 million newly insured Americans when the reforms are fully enacted in 2014, experts say the healthcare system will be facing a deficit of more than 150,000 primary care physicians over the next 15 years.

Despite the number of new positions the legislation appears to promise, some questions remain. As healthcare organizations weigh the number of newly insured patients against a low number of providers and budget realities, staffing decisions will be made carefully. Additionally, the push for electronic health records and the transition to ICD-10 will continue to strain many organizations, especially smaller practices. These issues will also hinder major decision making at larger facilities.

However, one thing is clear: NPs and PAs will become critical members of the healthcare team in 2013 and for years to come.

"Year after year, facilities go through their budgets, making tough hiring choices," said Renee Dahring, MSN, NP, a nurse practitioner in Minnesota who also provides resume and career coaching services. "But increasingly, healthcare facilities face the choice of hiring one physician or multiple NPs and PAs. People are happy with our care, and as they get to know us better, NP and PA hiring will continue to surge."

Jason Daeffler, marketing director for Barton Associates, a locum tenens staffing and recruiting firm, added, "I believe the PPACA will have a positive impact on job opportunities. NPs will be in high demand and have a great opportunity to step up and help provide high-quality primary care services to the growing population of covered Americans.

"Whether working alongside primary care physicians in a team environment or opening their own practices, NPs will be instrumental in mitigating the effects of the physician shortage and meeting the needs of these patients," Daeffler said.

Now more than ever, nurse practitioners and physician assistants will face opportunities for employment and expanded influence.

"While the increase in patient volume due to new universal healthcare coverage under the Affordable Care Act may not been seen in full effect until 2014, I expect hospitals and health systems to increase hiring for NPs and PAs beginning in 2013," said Robert Murray, sales manager for the job opportunities division of ADVANCE for NPs & PAs. "This is due in part to the more stable and predictable landscape of healthcare facilities' business environments, as well as the need to fill the gap in primary care availability."

National Support

Throughout 2013, NPs and PAs can expect to see considerable support from their national organizations. The consolidation of the American Academy of Nurse Practitioners and the American College of Nurse Practitioners late last year created the American Association of Nurse Practitioners (AANP), a unified organization ready to take on the world in the name of NPs. AANP president Angela Golden, DNP, FNP-C, FAANP, said the group expects a strong 2013 for all NPs.

"We predict a growing demand for nurse practitioners," Golden said. "The need for an increased number of NPs in suburban, rural and underserved urban areas continues to grow, and the demand for more primary care providers remains a critical issue. With more than 80% of NPs prepared in primary care, we will be the fastest growing segment of the primary care workforce and at the forefront of meeting the needs of our nation."

AANP is taking legislative action to ensure 2013 continues to show growth for all NPs.

"On the federal level, AANP's policy team is active with the Centers for Medicare and Medicaid Services, the Department of Health and Human Services, the National Health Service Corps and legislators to ensure that adequate funding for graduate nursing programs is achieved and that grants and loan repayment programs continue to include nurse practitioners," Golden said. "In the states, AANP is actively working to bring about state practice law changes that provide NPs full practice authority and uncouple the link to medicine."

American Academy of Physician Assistants (AAPA) president James Delaney, PA-C, said the nation's appetite for physician assistants is insatiable. "This market is terrific," Delaney said. "It's a great time to be a PA."

As the healthcare marketplace prepares for the influx of new patients, PAs are in a prime position to grow.

"Not only will we see a shortage in primary care in 2013, but in general surgery, urology, orthopedics, plastic surgery and cardiothoracic surgery," Delaney said. "There are unlimited employment opportunities for PAs. We just need to make sure we get this workforce ready to use."

Delaney said that to achieve the goals of physician assistants nationwide, AAPA is working at the federal and state levels to advocate for modern PA practice, Medicare reimbursement, direct reimbursement for PAs owning their own practices, and state and local mandates to ease barriers to physician assistant practice.

"We bring a huge value to the healthcare team," Delaney said. "We're in the right place at the right time."

New Prospects for New Grads

For new graduates, the class of 2013 is entering the workforce at the best time in recent years. According to the National Association of Colleges and Employers, companies expect to hire 13% more college graduates in 2013 than they did in 2012.

Organizations like AAPA and AANP are striving to make the transition from student to professional easier with career resources, credentialing information and job boards.

"New graduates are one of the primary focuses of the AAPA," Delaney said. "We have resources for finding the right job, creating a resume, contract negotiation, marketing yourself, interviewing, and links to state practice acts."

Similarly, AANP offers new graduates several avenues of assistance for reaching career goals.

"In 2013, AANP will have three tangible ways to help new graduates and continuing job seekers with employment," Golden said.

"We have deployed our 'Starting Your Career' website area to assist new graduates in securing jobs, we are continually connecting NPs to employers across the world through our 'CareerLink' resource, and we are expanding continuing education and professional development offerings to our members."

Despite the availability of career resources, finding that first nurse practitioner job can still be a struggle for some new graduates. Susan Jackson, RN, BSN, MSN, ANP-C, a 2012 graduate of the University of Cincinnati adult nurse practitioner program, said that the salary offerings for new graduates can be problematic.

"I was recruited by a physician prior to graduation on the basis of my experience," Jackson said. "However, the salary that was offered by the physician was very close to the salary that I was making as an RN. I declined the position."

For Jackson, who was at the top of the RN pay scale after more than a decade of practice, many job offerings are not an increase over previous salary.

"I have paid a significant amount of money to go back to school," she said. "I also will be taking on a significant amount of responsibility and liability, which should account for an increase in the salary offered."

Jackson said that another major barrier in the job search is the pressure an NP faces.

"As an RN, there is more room to change your position if you are unhappy," she said. "But as an NP, you don't want to develop a bad reputation. Patients are making appointments to see you - you aren't a behind-the-scenes person anymore."

For recent graduates in Jackson's position, Dahring suggested stalling the job search, but only temporarily.

"Experience is experience," Dahring advised. "You need to get working, even if it's not as an NP. Just don't put it off for too long."

Temporary Positions Grow

For some new graduates or seasoned clinicians seeking a new position, locum tenens employment has a great draw. These temporary positions allow NPs and PAs to gain experience in a variety of healthcare facilities across the country, without signing on long term.

"We are seeing more healthcare organizations requesting locum tenens NPs in a variety of medical specialties such as primary care, pediatrics, emergency medicine, psychiatry, internal medicine, dermatology, and surgery," Daeffler said.

"As more organizations and practices recognize the quality care that nurse practitioners provide and more states revise their scope-of-practice laws to allow nurse practitioners to practice to the extent of their licenses, the number of NP locum tenens opportunities will continue to grow."

Daeffler said nurse practitioner locum tenens staffing more than doubled in 2012, and he expects a similar increase in 2013.

"We expect this trend to continue as organizations grapple with the physician shortage and increased demand for services," he said.

"Locum tenens NPs give organizations the flexibility they need to provide quality care, ensure continuity of care and patient access, and maximize revenue generating opportunities."

A Surge in Convenient Care

Like locum tenens positions, convenient care facilities offer an alternative to traditional practice settings for nurse practitioners and physician assistants. Sandra F. Ryan, MSN, CPNP, FAANP, chief nurse practitioner officer and clinical advocate for Take Care Health Systems of Walgreens, said nurse practitioners and physician assistants will continue to play a vital role in healthcare delivery, and especially within the convenient care industry.

"Nurse practitioners and physician assistants will be key in early detection, education and ongoing management of illnesses, with a focus on improving overall healthcare outcomes," Ryan said. 

"Job opportunities for clinical, managerial and leadership roles will continue to grow and we will see even more involvement of these professionals in helping to shape the future landscape of healthcare."

Ryan said that in 2013, nurse practitioners and physician assistants will continue to be viewed as increasingly valuable members of the healthcare team.

"NPs and PAs will be recognized for their unique education, skills and approach to healthcare delivery," Ryan said. 

"They bring to the healthcare industry experience, a wealth of knowledge and incredible dedication to taking care of patients and collaboratively working with other members of the healthcare team."

Ryan said that a major goal of convenient care in 2013 is to employ PAs in all 50 states, as is possible for NPs.

"PAs are currently being hired [for convenient care] only in select states due to regulatory constraints that exist," Ryan continued.

"The goal is to be able to hire both nurse practitioners and physician assistants nationally and to reduce unneeded oversight or regulatory practices that interfere with access and do not contribute to improving quality of care delivery or patient safety," she said.

Advice for Seeking a Job in 2013

As the year progresses, industry experts expect to see a continually higher number of NPs and PAs in healthcare facilities across the country.

For nurse practitioners and physician assistants seeking new job opportunities this year, experts recommend being confident, technologically savvy and well informed.

"We are in a unique point in our history where nurse practitioners and physician assistants need to step up and be in discussions about how to help shape the future of healthcare for our patients," Ryan said.

"Work to ensure that healthcare access is there for the patients we serve and remember that change, innovative technology and collaboration with other professionals will make us successful in meeting the healthcare needs  of the future."

Delaney said that for physician assistants, it is important to remember the value you bring to your practice and your patients.

"PAs do great things in many areas," he said. "Be aware of what you bring to the table."

For nurse practitioners, a similar confidence is the key to success.

"Four decades of exceptional, quality care have earned NPs a highlighted role in our nation's healthcare discussions," Golden said.

"NPs will continue to be at the forefront of healthcare in 2013 as long as we continue to be at the forefront of patient care."

When looking for a job, take advantage of all networking opportunities and investigate all avenues.

"Employment is gained in different ways than it used to be - through social media and email, not newspapers and job boards," Dahring said.

"If you're not active online, you will get missed."

Jackson added that for new graduates, networking should include personal inquiries.

"Let every physician you encounter know that you will be looking for a position when you graduate," she said.

"Nurse practitioners and physician assistants shouldn't settle for something they won't enjoy. Hold out for the right position."

Kelly Wolfgang is the assistant editor of ADVANCE for NPs & PAs. Reach her at kwolfgang@advanceweb.com.