A recent article in the Wall Street Journal focuses on the increasing use of nurse practitioners (NPs) and physician assistants (PAs) in filling patient care gaps in our medical system. There are now 461,000 NP active, an increase in 61% since 2019. They function in much the same way as do family practitioners; the same is true for PAs.
They make diagnoses and prescribe medication just as physicians do. They function with minimal or no regular oversight by MDs. This increase in numbers and independence has, of course, provoked criticism from primary care physicians. They cite the difference in training (two years versus seven years) for limiting the independence of NPs.
Almost all of this criticism is without justification. Most family practitioners are overtrained for the illnesses that make up the vast bulk of their practice. The routine aches and pains and straightforward, common illnesses that comprise 95% or more of their patient encounters do not require two years of basic science courses, while much of their clinical rotations could be easily compressed. That this is so is the success of NPs in handling the common illnesses that they manage effectively.
When a problem that goes beyond the qualification or familiarity of the training and experience arises, they do the same thing that a family practitioner does – they refer the patient to the emergency room or to a specialist.
The need for these physician extenders is particularly great in rural areas that have trouble recruiting MDs.
The increasing demand for medical care will overwhelm any objections to the use of NPs and PAs. As long as they use consultation and referral properly, they will provide a badly needed service at a cost-effective price.
The number of doctors who enter practice in the US each year is limited by the number of residency positions available. The country has a severe shortage of primary-care physicians. This deficit is worsening every year as medical school graduates preferentially enter higher paying specialties. NPs and PAs are filling this need. They require less training and receive a lower salary than do primary care doctors.
Nurse practitioners make an average income of $132,000 a year compared to the $257,000 average for primary-care doctors. PAs earn, on average, $133,000 yearly. They both are filling a real medical need that will only increase as the population ages. The need for these physician extenders is particularly great in rural areas that have trouble attracting primary care MDs.
Over the past two decades, around 30 states have given nurse practitioners the right to practice without physician oversight. Ten states let physician assistants – who generally have a minimum of six or seven years of clinical training and higher education – practice independently as well. And five states have passed laws changing the title of physician assistant to physician associate. The name change another example of putting lipstick on a pig. It does nothing to add to the real usefulness of PAs.
Despite the objections of physicians who object to the independence of NPs and PAs, there’s little to no evidence that their increasing use harms patient care. The reality of American medical care and the nature of most medical visits support the increased use of these physician extenders. They serve a real need and do so at a reasonable price. I see no reason, other than self-interest, for physicians to object to their use.
