While working on a graduate degree 30 years ago I was required to design a research project and conduct a survey. For my project I asked people if they would be willing to see a lesser-trained medical provider, which I defined as a Master of Medicine. I used the title Master of Medicine because nurse practitioners were not well known at the time with only about 10% the number there are now. I also didn’t want to bias my sample with the title nurse. My professor was something of an elitist with a PhD. She scoffed at my project, literally laughing at the idea of seeking care from someone with less training than a doctorate. Yet nearly two-thirds of the people I surveyed said they were fine receiving care from a master’s level practitioner, with some caveats. The caveats included cost differences, waiting time differences and patient health status. In general, when the wait was lower, cost was lower and health status good, patients were more likely to accept care from a Master of Medicine.
The American Medical Association (AMA) claims that physicians have nearly 20,000 more hours of clinical training than nurse practitioners or physicians’ assistants. That works out to a decade of full-time clinical experience. These statistics are usually expressed in opposition to expanding the scope of practice of so-called midlevel practitioners. Nonetheless, the role of NPs/PAs is growing. USA Today explains the implications of various levels of training.
As providers with advanced degrees become more prevalent in health care facilities, experts say more research needs to be done and conversations had to determine where and how their skills can be most beneficial.
Past research has found that patient slightly satisfaction is higher among those who see nurse practitioners. Hint: it’s not about training. It’s about listening. Patients feel less rushed and listened to more. Over the years I’ve talked to a few people about their experiences with NPs/PAs. Concerns are often blamed on the supervising doctor, as in “Dr. Smith won’t allow use to prescribe antibiotics…,” which may partly explain differences in provider satisfaction.
Data shows patients have similar health outcomes regardless of whether they see a physician, physician assistant or nurse practitioner in primary care settings, but the jury is still out in other settings, like emergency departments and specialty care.
The above paragraph makes an important point. Each level of provider has a place. Each level should work up to their level of competence, but not exceed it. From an economic perspective, the health care system does not always utilize physicians efficiently.
“There’s a lot of medicine that requires the care of an M.D. but there’s a lot of medicine that doesn’t, and the key thing is to allocate providers to the places where they’re needed and likely to be most effective,” said Dr. Anupam B. Jena, professor at Harvard Medical School…
The key is for all providers to know when to refer patients to more highly skilled providers. A family physician will quickly refer patients to specialists, when a patient’s condition is complex. A nurse practitioner can and often does the same, recommending a patient see the doctor when there is a question about care.
Why are the number of NPs and PAs growing? It’s partly due to the physician shortage. While it would be great for everyone to have a medical doctor many cannot find one. From an efficiency standpoint, it makes little sense to require people to see more highly trained professionals than they need. The more highly trained, the greater the cost. This is especially true if patients cannot find a physician with an opening in their schedule.
While physician assistants and nurse practitioners play a huge role in medicine, health experts say it’s important to not overlook their limitations.
“There’s a lot of places where nurse practitioners and physician assistants can probably do very well in health care but other places where they don’t,” Jena said. “It’s important not to overextend and put people in situations where they wouldn’t thrive in.”
Indeed, most NPs and PAs also agree.
Patients need a range of skills at different prices. Appropriate policy should allow providers with varying levels of training to work up to his or her competency.
The entire article is an interesting read: Physician assistant, nurse practitioner or doctor: What patients should know
My view of PAs was formed when I was much younger and believed the urgent care clinic was a reasonable substitute for a regular primary care doctor. At that time, I had the sense that PAs tended to view themselves as the middle rung of a ladder, with the MD at the top and patient at the bottom. I tended to have a much better experience when I was able to talk to an actual doctor. Obviously based on limited experience though, as I never thought of NPs that way.