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).
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> 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.
