By Sean Wilkes, MD
USA Today recently published an article titled “Physician assistant, nurse practitioner or doctor: What patients should know,” and while it provides a valuable perspective on the evolving landscape of healthcare, there are some critical nuances that need addressing.
First and foremost, the rigor of training that differentiates physicians from PAs and NPs cannot be understated. As the article rightly points out, “While physicians require at least four years of medical school plus residency, physician assistants and nurse practitioners need only about two years for their advanced degrees.” When one compares credit hours and clinical training hours this translates to primary care physicians undergoing upwards of four times the training that PAs receive and over eight times the training that NPs receive. This extensive training is not just about duration but depth, equipping physicians with a comprehensive understanding of a myriad of medical conditions and the expertise to handle intricate clinical scenarios.
The article cites studies suggesting that “patients have similar health outcomes regardless of whether they see a physician, physician assistant or nurse practitioner in primary care settings.” However, it’s important to note that these studies predominantly evaluated midlevel practitioners who were practicing under the direct supervision of physicians. The dynamics of care and decision-making can change dramatically in the absence of direct physician oversight, especially as many states are now granting NPs the authority to practice unsupervised.
Furthermore, the studies that the article references focus on very specific outcomes in a narrow collection of conditions and settings. They do not provide a sufficiently comprehensive picture of patient outcomes to draw broad conclusions about equivalency between physicians and midlevel practitioners. Medicine encompasses a wide variety of diseases and conditions, and the complexities of patient care cannot be boiled down to just a few select measures like smoking cessation, cholesterol, or blood pressure.
On the topic of costs, while the article suggests that “the cost of care for patients was lower among nurse practitioners and physician assistants compared to physicians,” evidence indicates that nurse practitioners often order more tests, place more referrals, and increase emergency department utilization (1). This pattern can lead to increased healthcare costs for patients. Additionally, nurse practitioners have been shown to be less productive than physicians in certain settings (2). This evidence suggests that unsupervised practice by midlevel practitioners may not be the cost-saving solution it’s often portrayed to be.
While PAs and NPs undoubtedly play an important role in healthcare and can complement and extend the care provided by physicians, it’s essential to recognize the differences in training, expertise, and the scope of practice. As we move forward in shaping the future of healthcare, it’s crucial to base policy decisions on comprehensive data that evaluates and compares the performance of all healthcare providers across various conditions and settings.
Sean Wilkes, MD
Member, Physicians for Patient Protection