American Medical Association’s Post

Major issue is the study is not shown in this report. The link is critical so that academics can review. I’ll try to search and locate the actual published report. That questions the validity of the report. The AMA is going to be forced to sit down with all healthcare providers to determine how to move forward. The AMA and physicians alone are not going to be allowed to make unilateral decisions on healthcare. Plus the AMA represents approximately less than a quarter of physicians and those who are members have told me they do not agree with the AMA approach, plus many nonphysician providers and physicians work very well together. But where there are no or insufficient physicians found and the need is great, the AMA can either lead or get out of the way. We need to find solutions for access to and the delivery of care. Not protecting the views of a few.

Sorry, perhaps the AMA should focus on aging Doctors and complaints to the medical board since the complaints re: doctors over age 70 make up around 85% of all complaints re: physcians to the medical board. I just had this situation happen where a doctor was exhibiting signs of dementia but everyone kept catering to his behavior: aggressiveness, not bathing, wearing the same clothes, stealing prescription pads from other providers, getting lost, and habitually being late and making his patients wait 1-2 hours for him??? He was 81 and severely unsafe

Any studies on if these patients had commercial insurance, Medicare or uninsured? I’m not saying patients are being kept longer because they have “good” insurance coverage vs patients who do not have an ability to pay…..But Let’s just say, before there’s a conclusion questioning NPs competence in the ER, look at all patient factors. (Unpopular opinion here, but this study has holes).

As noted below the actual study would have been helpful to allow readers to draw their own conclusions. This paper can be located at http://www.nber.org/papers/w30608. It is a working paper of 106 pages and heavy in statistical analysis. Several comments caught my attention. This paper looks at physician vs. NP but notes several issues immediately, such as patient assignment and complexity of the patients. This paper as written is for discussion ONLY. It has not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications. Using quasi-experimental variation in patient assignment to NPs versus physicians in VA emergency departments, they found that, on average, NPs use more resources and achieve less favorable patient outcomes than physicians. However, the NP-physician performance difference varies by case complexity and severity. They also stated that NPs perform better than physicians in 38 percent of random pairs. This paper needs a much closer evaluation before making statements as above.

There could never be an equivalency between nursing and medicine. That being said, there are not enough physicians for the demand. Large physician panels are correlated with higher incidence of burnout and other reported negative response’s. In a perfect world everyone’s care is led by a physician however that is not the current state of healthcare in the US. The cost for unmanaged chronic care conditions, particularly a combination of medical and behavior seen in veterans, cannot be managed by physicians only. What the study shows is that placing NPs in a focus for which they did not recieve formal education, leads to increase costs. The answer is to create standardized programs to address the knowledge gap, so unecessary spending is curtailed.

I disagree with this report. NP's are thorough and have intuition in addition to proper bedside manners. NP's making "poor decision making" maybe related to the amount of experience they have. I mean, if you have a brand new nurse practitioner in emergency room, and they are independent, of course, they are at high probability of making mistakes. But compare that level of experience with somebody who is very experienced and seasoned. Second, I disagree with poor quality of care. And maybe a bump in expenses? Maybe attributed to more thorough investigation and more labs and test ordered. Overall, the studies in the past have always presented nurse practitioners as competent and even as good quality as physicians. And looking at this source that was sponsored by the American medical Association, kind of gives you a clue as to the bias.

Has any study been done looking at physician associates

As a nursing student, I am aware that many of my colleagues plan to apply to NP school straight out of their BSN. I don’t think this would even be a conversation if NP schools— like CRNA programs— imposed a minimum length of working experience before even being able to submit an application. At least PA programs have this requirement— to be competitive for those programs, many if not most candidates are getting into the thousands of hours of patient care experience last I heard. And of course, you can’t even begin to compare length and intensity of training for most midlevels to that of even the physicians who had zero work experience before applying to MD programs (although a vast amount do, especially those that were non-trad applicants). I recently heard from a nurse that her hospital said they’d pay for her NP and then give her a job there in any NP opening there. She had less than a year of experience out of school. Who’s making those decisions? Go to the source of the problem. If someone sees a streamlined way to get to better pay and work-life balance, they’re likely going to do it. If I didn’t already want to be a physician ultimately, I would absolutely see the appeal of a fast track to work as a midlevel.

https://www.nber.org/system/files/working_papers/w30608/w30608.pdf It is a lot less of the wow factor when you read the article and learn that the inter professional variation is even greater and that a randomized pairing leads to NPs having higher quality of care than physicians by 38%, and that the interprofessional performance has greater variation in professions vs compared to one another. We should certainly look at this deeper but this title is inflammatory and in a post COVID era with increased physician compassion fatigue, and increased ED patient demand, we can’t rely only on Physicians there simply are not enough resources to meet the demand which would increase poorer outcomes.