Profit Over Expertise: NP’s and PA’s Fuel Over-Prescribing Risks. Pharmaceutical Companies Profit & Patients Can be Harmed.

Across the United States, large corporate health systems and hospital conglomerates are increasingly replacing board-certified physicians with nurse practitioners (NPs) and other non-physician practitioners. Driven by corporate influences to maximize profits, health system executives frequently market this strategy as an “access-expanding” solution. However, beneath the rhetoric lies a concerning reality: substituting fully trained medical doctors with mid-level practitioners who possess a fraction of the clinical education creates risks to patients, from widespread diagnostic errors to unnecessary testing, and dangerous over-prescribing of medications.

The fundamental danger stems from the wide difference in training and education between physicians and non-physician prescribers. A board-certified physician undergoes four years of medical school followed by three to seven years of intensive residency and fellowship training, accumulating between 10,000 and 16,000 hours of supervised clinical experience.

By contrast, nurse practitioner programs require as few as 500 clinical hours—many of which are now obtained through online degree programs with minimal standardized oversight. When faced with an undifferentiated or complex patient, this training deficit frequently manifests as diagnostic inaccuracy. Rather than pinpointing underlying conditions, less-trained practitioners are prone to ordering excess diagnostic tests, issuing inappropriate specialty referrals, or missing critical diagnoses entirely [1, 2]. Even in simple cases such as an acute respiratory infection, there are studies showing NPP’s prescribe antibiotics, which are unnecessary, at up to 30% higher rates than physicians. [3]

The nursing model of clinical reasoning, assessments, and management plans is completely different from the physician’s medical model of clinical reasoning, diagnosing, and care plan. A physician makes a medical diagnosis which emphasizes determining the underlying cause from a wide range of signs and symptoms, while a nursing diagnosis is often a description of the symptoms and conditions. Diagnostic uncertainty among NPs can lead to over-prescribing pharmaceutical drugs as the default mechanism to manage symptoms. The downstream consequences of this over-prescribing and misprescribing are catastrophic for public health [4]. Unnecessary or incorrectly tailored drug regimens contribute directly to the ongoing opioid crisis through over-prescription, leading to substance use disorders, accidental dependence, and preventable deaths [4]. In psychiatric care, low diagnostic precision frequently results in dangerous polypharmacy—stacking multiple psychotropic medications to suppress overlapping symptoms, which increases the risk of severe drug interactions and cognitive decline [4]. Furthermore, the routine misapplication and overuse of broad-spectrum antibiotics for viral or self-limiting infections accelerate global antimicrobial resistance while overwhelming retail pharmacy teams who are left to filter out potentially hazardous drug interactions [4].

Compounding the problem is the vulnerability of non-physician prescribers to pharmaceutical industry marketing. For years, financial incentives and drug maker marketing specifically targeted non-physician practitioners who operated outside federal oversight. The Physician Payments Sunshine Act—originally enacted in 2010 to mandate public disclosure of pharmaceutical payments to physicians—was only expanded in 2021 to include nurse practitioners and physician assistants [5]. Subsequent nationwide analyses revealed that over 52% of active Medicare Part D advanced practice prescribers were receiving direct industry payments [5]. Following the transparency expansion, NP prescribing patterns demonstrated a measurable shift toward generic drugs, confirming that practitioners with lower levels of pharmacological and medical training are highly susceptible to targeted pharmaceutical promotion and financial incentives [5].

Despite mounting evidence that unsupervised NP practice leads to higher emergency department utilization, longer hospital stays, a 20% increase in 30-day preventable hospitalizations, and millions in excess healthcare spending, corporate health systems continue to push for expanded scope of practice [1, 2].

In a fee-for-service or corporate environment, extra laboratory orders, repeat imaging, and specialty consults generated by diagnostic uncertainty actually drive hospital revenue while cutting labor overhead. Restoring patient safety requires confronting this profit-driven model. Policymakers, state licensing boards, and healthcare institutions must reinforce physician-led care, curtail unsupervised non-physician practice, and prioritize rigorous clinical expertise over profits.

References

1. Batson, B., et al. (2022). “Targeting Value-Based Care: Primary Care Provider Comparison.” Journal of the Mississippi State Medical Association. (Analyzing 15 years of clinic data, finding that NP-led care resulted in $28 million in higher annual costs due to unnecessary testing, emergency department visits, and specialist referrals compared to physician-led care).
2. Chan, D. C., & Chen, Y. (2022). “The Productivity of Professions: Evidence from the Emergency Department.” National Bureau of Economic Research (NBER) Working Paper No. 30608. (Finding that unsupervised NPs in emergency departments increased resource utilization, extended length of stay by 11%, and caused a 20% increase in 30-day preventable hospitalizations).
3. Hersh, Adam L, et. al. (2023). “Comparison of antibiotic prescribing between physicians and advanced practice clinicians” Infection Control & Hospital Epidemiology, Cambridge Unviersity Press. 
4. Health Affairs Scholar (2026). “Downstream Effects of Inappropriate Prescribing and Diagnostic Mismanagement in Advanced Practice Nursing.” Oxford Academic, 4(1), qxag004. (Detailing the systemic impacts of over-prescribing, including opioid use disorder, psychiatric polypharmacy, antimicrobial resistance, and pharmacy staff burnout).
5. Nadeem, H., Li, J., Donovan, L. M., Feemster, L. C., Au, D. H., & Duan, K. I. (2026). “Sunshine Act Expansion and the Prescription of Generic Medications by Advanced Practice Providers.” PMC / Health Affairs Scholar, PMC12822597. (Demonstrating that APP prescribers shifts toward generic prescribing following mandatory disclosure under the expanded Sunshine Act, reflecting industry payment susceptibility).