Nurse Practitioners instead of Family Physicians?

[hkmedbound]

If nurse practitioners (NPs) ostensibly have the same (or very similar) scope of practice as family physicians, why don't we increase the number of practicing NPs and phase out family physicians?

 

"This would save the health care system money, increase the number of 'gate keepers' in the system, and would force more medical students to specialize therefore increasing the number of specialists..."

 

I’m not an advocate for this whatsoever, however, it was an interesting argument made by a colleague last week. Any opinions?

[SpanishFly]

well from what I've read (and seen at work), the initial purpose of having NP take over many of the physicians responsibilities don't necessarily reduce wait times to see the MD nor does it reduce their work load, and according to the Cochrane report, it doesn't reduce costs despite the lower salaries. Also, while both groups may have similar outcomes on patient care, there are mixed results from patient satisfaction (with some reports indicating nurses had higher satisfaction scores and others indicating doctors did, but limitations to many of these studies are that they don't do a lengthy follow-up of these pts.).

 

Anyways, as far as I'm concerned, if there are no significant improvements to the system by using NP instead of physicians, than I don't see why we need to take away a physicians job and give it to someone else under the misconception that it will help.

 

http://www.ncbi.nlm.nih.gov/pubmed/10632281?dopt=Abstract

http://www.nursingadvocacy.org/faq/apn_md_relative_merits.html

[truffle]

Anyways, as far as I'm concerned, if there are no significant improvements to the system by using NP instead of physicians, than I don't see why we need to take away a physicians job and give it to someone else under the misconception that it will help.

 

wouldn't that be cheaper?

[jpc43]

"Because nurses spent more time with each patient, however, they saw fewer patients per hour. In four of five studies on nurse-led urgent care, lower salary costs were offset by this so-called "lower productivity" and increased use of resources.

 

"As salary differentials between nurses and doctors may vary from place to place and over time, the net saving to health care services, if any, will be highly context dependent," note the reviewers." - The Cochrane report mentioned above.

 

Additionally, I would expect to see the salaries of the NP's to rise over time to a level similar to that of a GP. I mean, if I took over all of the responsibilities that come with your job, and did it just as well (as the report indicates), I would want to be compensated equally!

[A-Stark]

I don't think there is much rationale or push to *replace* physicians with NPs, but they are an important part of team-based care. They can do initial histories and examinations, for example, freeing up time for care and management of more complex patients.