Interesting; on the one hand, one could dismiss this as an 'in other news, water is wet'-type of study, but such evidence is probably very helpful in the overall debate around healthcare funding.
Another factor not mentioned here but which might be relevant, is that as long as nursing is undervalued (particularly economically, but in less tangible ways too) to the extent that the system is short of nurses, it is unlikely that employers would able to choose pick and choose better nurses from those available, and/or remove bad ones. It seems obvious from an organisational perspective that nurse > no nurse, but there's a direct link (in my experience) between the quality of care patients receive, and the attitude/experience/quality of the individual nursing staff.
One lesson might well be that the relative pay gap between senior nurses and senior doctors is too big - i.e. senior doctors should be paid less / we should employ fewer doctors and more nurses. But that's probably a very very hard thing to actually do politically both in terms of internal hospital/NHS politics and national politics.
There are strongly entrenched interests in the NHS which I suspect constrain relative pay between professions and grades much more tightly than they constrain absolute pay numbers.
In the US I typically receive very poor care from people with the title "Nurse Practitioner" who are usually hired for the exact purpose of getting people to do doctor-like work for cheaper. They are ok at dealing with very normal conditions like the flu/cold, acute non-critical injuries, etc. (which you honestly don't even need to get care for anyway) but not good at dealing with issues outside of that
> Relevant Research Findings
There are two landmark studies on the quality of the primary care delivered by nurse practitioners in regards to that of physicians. The first was by Mundinger, et al. (2000) and a follow-up study by Lenz, Mundinger, Kane, Hopkins & Lin (2004).
...
> The results indicated tllat there were no significant differences in patient outconles regarding health status, physiologic test results or health status utilization. Patients seen by NPs did have a statistically significant, but not clinically significant lower diastolic blood pressure (82 vs. 85 mm Hg; p==.04).
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> The outcomes compared were health status, utilization of health services, and satisfaction with health care. The investigators found no significant differences in outcomes between the two groups, one seen by MDs and the other seen by NPs. The only difference in the results is the average number of primary care visits during year two for each discipline
You left out a crucial sentence from the paragraph you cited:
> The study was a randomized double-blind trial to compare outcomes of patients assigned to either NPs or MDs for follow-up care after initial management at either an emergency department or urgent care clinic for asthma, diabetes, and/or hypertension.
This excludes what I originally meant to refer to, which is non-routine care. I am fully confident that NPs can handle routine care, what I was asserting is that they are (anecdotally) bad at handling more complex/infrequent issues
Well if that’s what you were referring to I’d say the average NP would agree. They’re not meant to handle non-routine care, they’re meant to kick that upstairs to someone more qualified.
The bigger issue this discussion is pointing to is how too much power/status/etc is concentrated among physicians in healthcare. It's too hierarchical. Not saying physicians are poor at their jobs, but there's very little evidence, when any evidence has been collected, that when another type of provider, with a different educational and training history, has moved into roles previously occupied by physicians, that outcomes are any different.
So, for example, I doubt that if NPs were specifically trained in specialty area X, you'd see any real differences. If we're going to do anecdotes, my personal experiences have been that the care provided by NPs (or PAs) has not been any different from physicians, even in relatively specialty areas I've dealt with. In fact, in some ways the care was better because we weren't trying to pressured into expensive procedures with absolutely zero scientific evidence of improved outcomes (having a hammer makes everything a nail).
What seems to be going under the radar is that the vast majority of MD programs are moving to 1.5 years or even less of academic training, with the rest being a variety of clinical experiences and quick rotations. This is fine, but what it means is that if you have a need for a provider in specialty area X, there's little difference between an MD + 4 years of specialty training, and something like a PA or NP + 6 years of training. We could get into discussions about academic preparedness, but at that point you're making a lot of assumptions averaging over individual variability, and ignoring things like nurses often having a ton of very technical training in actual physical technique.
I would love nothing more than for competition to open up dramatically in healthcare in terms of access, training, provider, and administrator models. This is happening to some extent now but it needs to be dramatically expanded. I see very little empirical or logical reason to assume that 4 years of general MD/DO training to something more specialized, is better than alternate training trajectories. Many of the professions in healthcare, such as nurses, PAs, pharmacists, psychologists, dentists, optometrists, etc. could be dramatically increased in scope of care, and new roles created that don't even exist currently, if there wasn't such territoriality and hierarchy in healthcare. Costs are spiraling currently in part because of rent-seeking problems. We've built our current system on a very dated set of stereotypes and outmoded assumptions, and are paying for it.
In Australia I've also received poor care from people with the title "General Practitioner", I think the principle of "90 percent of anything is crap" applies to Doctors just as much as it does to Nurses.
Probably a better approach would be less pay for better quality of life jobs* which would still require more doctors and slightly more overall pay.
Also a lot more nurses; since with the baby boomer generation in and entering retirement the need isn't going to go down relative to historic levels.
* Edit:
By better quality of life I mean things like having a 4 x 8 hour shifts with each having about 2 hours of overlap for review of records, passing down, and filling out post shift paperwork. Yes nurses would need similar shifts, the overlap also gives time for the transfer of knowledge, in the process of getting it entered/updated in the health record systems.
A lot of nurses already work 3x13 or 4x10-12 shifts, many also work secondary nurse staffing (temp/onsite) jobs beyond their regular work. The work is definitely under valued, and there is some range in pay, but the top caps out relatively low for the knowledge and experience.
Some locations don't allow nurses to unionize or strike. In AZ, for example, there's an inverse-union all the hospitals joined that member providers for staffing have to comply with contracted rates, etc. Which I don't know why it doesn't go afoul of the right to work laws here, I don't know (probably lack of prosecution).
In the end, it varies a lot and at some point there will definitely be more collective negotiation going on. Pay will have to go up in a lot of locations.
Another factor not mentioned here but which might be relevant, is that as long as nursing is undervalued (particularly economically, but in less tangible ways too) to the extent that the system is short of nurses, it is unlikely that employers would able to choose pick and choose better nurses from those available, and/or remove bad ones. It seems obvious from an organisational perspective that nurse > no nurse, but there's a direct link (in my experience) between the quality of care patients receive, and the attitude/experience/quality of the individual nursing staff.