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Are NPs and PAs "ruining medicine" for physicians?

I was recently quoted in an article for medical economics: What's ruining medicine for physicians: Replacing primary care physicians with NPs/PAs.

Here's what the article says, and what they got right, and what needs a bit of clarification.

“One of the biggest concerns [physicians] have is the development of diploma mills—NPs in particular are being churned out of online programs,” says Rebekah Bernard, MD, board member of Physicians for Patient Protection, an advocacy group for physician-led healthcare.

She adds that there is no standardized education for NPs and PAs, so knowledge and training can vary widely among graduates. “The gap in required education is staggering—physicians aren’t allowed to practice until we have trained for about 20,000 hours, while NPs may have 1,000.”

I was slightly misquoted here - I am more concerned about the lack of standardization in NP programs - I believe that PA programs do have more standardization, although I DID note that PA programs are beginning to offer online training, which I find concerning.

The article continues:

"Yet NPs are often promoted by health systems and nursing programs as being “just as good” as doctors and are now allowed to practice independently in 23 states.

The push for more non-physician providers in primary care is coming not just from healthcare organizations looking to reduce costs, but from patients who want more convenient access to providers. These patients often lack respect for the amount of training it takes to be a physician and want instant answers and quick care, and a nurse practitioner at a retail clinic can often provide that, even though it may incur a higher risk, says Bernard."

Let me clarify, as this is also a bit of a misquote. I don't believe that patients lack respect for physician training - I think that often they simply DON'T KNOW, or they have been misled to believe that the difference in training doesn't matter.

As the article points out:

“The biggest thing with a new NP is they don’t know what they don’t know,” she says. “They don’t have the experience, and really don’t realize how quickly something can go wrong.”

Here's something that truly does hurt physicians in the current health care system:

"Doctors working for health systems can be assigned supervisory duties over non-physician providers who may or may not have appropriate training, putting physicians who are already short o

time in a position of having to assume liability for supervising them.

“There’s no oversight on hiring or how helpful they might be, but doctors are expected to supervise them or they’ll be let go,” says Bernard. “Physicians should be extremely aggressive if doing true supervision and not just sign off on charts. Understand their knowledge base and there should be true collaboration.”

Bernard says collaboration is the key."

No, not collaboration. I didn't use that word. I prefer the word SUPERVISION. Collaboration is a word that nonphysician providers (NPPs) have come up with to make it seem as if they are able to work independently and physicians are more their peers.

SUPERVISION is the key.

As the article points out: "Laws should limit what NPs or PAs can do on their own, and they should always have to work under the supervision of a physician."

Physicians, if you agree with me, please join Physicians for Patient Protection. Our goal is to educate physicians and patients on the importance of physician-led care, advocate for truth in healthcare advertising, and ensure that all patients have the opportunity to be treated by a physician when they so desire.


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