[tells]

The academic rigor that nurses and PA's must go through is not the same as a doctor. There are many instances where a nurse or a PA would unknowingly pass something off as normal when a more trained eye could save a persons life. We shouldn't be dumbing down our medicine. Create more medical schools while keeping the bar high for quality of care.

[rhexs]

I stopped going to NPs years ago when I found I could get better information via just searching for my existing diagnosis and reading the uptodate article. They're certainly useful if you're at the grocery store and need a quick prescription...but that's about it. Granted, that's probably good enough for most medical issues and patients coming in with colds.

The frustrating part is that I've found many specialist clinics that will do a one visit intake appointment with an actual MD then pass you off to the NP for follow-up visits. The strange part is that the NP is billed at the exact same rate. I'd be happy if I was paying ~50 an hour for an NP versus 400 an hour for the specialist, but that isn't the case.

[Scoundreller]

Wait until you don’t even get an NP, but get an even lesser trained Physician’s Assistant but pay the same.

[krapht]

This goes for all professions. If only $x-person was more highly credentialed then they wouldn't have made $y-mistake.

That's fine until $z-cost-of-service is > $some-number. I think we've reached that point in the United States where we can discuss reducing professional barriers to entry in order to bring down costs.

[Engineering-MD]

Your argument is sound, but the cost of tests/treatments and overall number of staff dwarf this amount. By training the top grade more and giving more weight to their clinical acumen, you could save costs on unseeded tests and treatment. Having said that as a physician I am biased.

[throwaway62333]

The opposite can happen too — nurse practitioner immediately demanding unnecessary biopsy or other tests because they cannot confidently rule something out. This happened to me recently when I went to a np for a known problem I have had for years that was already diagnosed by multiple doctors. I also find np is much more likely to prescribe antibiotics. Of course this is all anecdotal. I used to be very much in favor of expanding the scope of what nurses can do but now I feel like that may do more harm than good.

[Scoundreller]

Not only anecdotal, but unknown which one is more correct.

Any biopsy or test that comes back negative could be considered unnecessary, but we don’t know that in advance.

Is it worth testing for a 5% likely disease that would be serious if found? Not running it will save time/money 95/100. Doesn’t mean it’s the right approach.

[kradroy]

A psych NP was the only person who correctly diagnosed my condition and treated it successfully. I went to 5 psychiatrists in 10 years who couldn't get it right. She had worked in a hospital setting for quite a while. I'm guessing the psychs did the minimum necessary.

[jmb12686]

Not sure why this was down voted. Having many medical professionals in my family, I have come to understand this particular issue. Not much different than an inexperienced airplane copilot or junior developer.

Those with less training (nurse anesthetists to be specific) tend to get themselves into trouble and only then call on a MD trained anesthetist for assistance. Furthermore, hospital networks are able to more easily "push around" nurse anesthetists which in the end creates an environment where bad decisions can occur.

To make a distilled analogy, this would be the potentially niave junior dev, pushed by management to ship code / tech debt, despite the advice or mentorship from a senior dev, and only asking for assistance when production is on fire.

However the topic of cost management and profit tactics in US medical system is a broader topic, hospital system administrators and their C-suite management in the USA love cheaper alternatives that are directly employed by the hospital (think nurses, PAs, nurse anesthetists, etc). The hospital system can directly enforce efficiency metrics (think, more money for the hospital, not better care for the patient) and doesn't have to negotiate contracts with a group of specialist doctors.