[daveaiello]

One thing that appears to be unmentioned in this journal article is the explosion of nurse practitioners, physician assistants, and other medical professionals with "different" educational and training standards.

The impact that these people have had on primary and specialty care disciplines in the United States is huge, with both good and bad implications for cost control and quality of care.

One could argue that the explosion of nurse practitioners has had a greater recent impact in these fields than the near tripling of osteopathic medicine graduates over the 25 years covered in the article.

[darth_avocado]

The cost aspect is overblown. NPs and the other alphabet soup of primary care providers charge almost the same as an MD. And the quality of care isn’t the same. You end up getting the general “pop a Tylenol” or “I’ll give you a referral to a specialist” for the money you pay, which either makes the problems worse and/or expensive anyway.

[classichasclass]

Speaking as an MD, I think a distinction should be drawn between specialist and generalist midlevels. Specialists, and I include midwives here, do an actual residency and are usually excellent on the practical aspects. As a resident I learned a lot of my orthopedics from PA orthos, who were sharp cookies and in their field were highly useful adjuncts to the ortho surgeons for the bread and butter like uncomplicated fractures and surgical assists.

On the other hand, generalist midlevels have no explicit residency and even long-time midlevels who never really got any proper oversight can be nightmares. On internal medicine hospital call we used to groan when the urgent care paged us because we were always cleaning up their messes. I can't see how that saved any money or yielded equivalent outcomes.

[giantg2]

I generally agree. There are some scenarios where NPs or PAs are useful. Some may even be good. My personal experience has found them lacking... multiple times. And the charge has been the same since the practice is the one billing and charges the same whether you see a doctor or other provider.

[darth_avocado]

That has been my experience too. The only time I book appointments with NPs is when I know I need a specialist and want to skip the whole dance of “let’s do some tests and then determine that you need a specialist who will order the same tests”. It’s a cheat code to get better healthcare by working with the system.

[giantg2]

Luckily my insurance does not require referrals for specialists.

[kneebonian]

That's something interesting I've found over my much time sitting in hospitals. It seems like NPs are just Drs lite edition. But I question if we need all the training we currently have for doctors I remember reading a SSC article about how they don't require undergrad degrees in many countries and their drs. perform at the same levels.

Seems like in the US we just brought in NPs to fill the gaps instead.