Are Doctors and Nurse Practitioners/Physician Assistants Really the Same?

A week ago, I was asked to write an OpEd in response to the following AP article:

"Doctor shortage? 28 states may expand nurses' role"

http://news.yahoo.com/s/ap/20100414/ap_on_he_me/us_med_dr_nurse

Here's my response:

The three legs on which healthcare rests are Access, Cost, and Quality. We all agree healthcare is fragmented and horribly broken. Problem is, we are grasping at straws to try to fix it, instead of repairing the basic problem.

Mid-level providers, or physician extenders as some have termed them, have long been an essential part of healthcare provision. However, now, because of the perceived shortage and high cost of physicians, they, with the support of the government, are out to replace doctors.

As this article states, Nurse Practioners (NP), and Physician Assistants (PA) for that matter, are well trained, do spend more time with patients, and do cost less to produce and utilize than physicians. In addition, many of the compared outcomes are indeed similar – numbers of tests ordered, numbers of referrals, and overall health. But the beliefs that NPs/PAs are “as skilled” as physicians, and are “just like a doctor except for the pay” are misleading and incorrect. The wrong measures are being utilized to gauge differences and similarities if we want to assess true patient outcomes.

The pathway to even doctoral level NPs is nowhere as academically comprehensive or as clinically rigorous as the pathway to becoming a Board Certified Physician. The environment and the length of time in which each must train are likewise very different. To believe and promote the concept that the end result is the same, is intellectually dishonest and calls into question the entire proposition. The old maxim comes to mind, “When something seems too good to be true, it usually is”.

Despite all the rhetoric, the basic desire here is to enable one to shortcut the entire process of medical education by allowing less work for the same pay. In the end, it is the patient who suffers because of a lowered standard of care being propagated with regard to diagnostic acumen, disease recognition, and the depth and breadth of academic expertise. My advice to those wanting to be physicians? Go to medical school.

That said, we certainly need NPs and PAs. But to confuse the roles by equating them with MDs and DOs will only worsen our currently handicapped healthcare system. We must work together for the good of our patients and start by repairing the basic problem. Encourage the physician-patient relationship to be just that; and remove the economic and medicolegal pressures and distractions from the exam room.