Nurse Practitioners Can Make Health Care Cheaper

And Doctors Want to Stop Them.

"The major motivation in this opposition is kind of a turf war," says Dale Ann Dorsey, a nurse practitioner (NP) who runs her own women's health clinic in Scottsdale, Arizona.

A nurse practitioner is a registered nurse (RN) who has pursued extra clinical training and a master's degree and is able to practice medicine beyond the scope of what a regular RN can. How far beyond that scope NPs should be allowed to go is a question facing legislators across the country.

Arizona is one of 18 states that allow nurse practitioners to run independent primary care practices, with full prescribing privileges, and without the oversight of a licensed physician. Earlier this year, nurse practitioners in California pushed to liberalize scope-of-practice rules in the Golden State, only to be stopped dead in their tracks by the powerful California Medical Association (CMA), which poured more than $1 million into lobbying efforts in the first half of 2013 to defeat the legislation.

"[Nurse practitioners'] training is very limited compared to physicians," says Paul Phinney, a California pediatrician and former CMA president. "They lack a certain kind of experience that I believe is very important to the safety of patients and the quality of medical care that they're providing." 

He has a point. Physicians are required to obtain far more education and clinical experience than are nurse practitioners. But there's little to no evidence showing that, when it comes to primary care, all of that extra education makes any difference in the health outcomes of patients. A 2012 Health Affairs survey of the medical literature found no difference in patient health between groups treated by doctors and by nurse practitioners. The survey did find a slightly higher satisfaction rate among patients of nurse practitioners.

So if outcomes are similar, and patients are satisfied, why are states such as California hesitant to let more nurses open their own practices? The question is especially pressing since groups such as the Association of American Medical Colleges are expecting a severe doctor shortage in the near future due to the aging population. Reason Foundation analyst Adam Summers says that concern for the public good is a secondary consideration at best in this case.

"Licensing laws are almost always sold as being in the public interest," says Summers. "But in reality all they do is drive up prices and reduce competition, which reduces the incentive to provide good services to the consumer."

Watch the video to learn more about the nurse practitioners' struggle for clinical independence - a fight that just make health care cheaper and more available.

Scroll down for downloadable links, and subscribe to Reason TV's YouTube channel for daily content like this.

Approximately 5 minutes. Produced by Zach Weissmueller. Shot by Tracy Oppenheimer and Weissmueller. Graphics by William Neff.

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • Emmerson Biggins||

    If only you tea party obstructionists had any ideas of your own for how to improve our health care system. It's easy to criticize, but to really be part of the game, you have to propose your own solutions too!

  • Ted S.||

    I think the OP was being sarcastic, what with posting that in response to a post proposing solutions that might make healthcare cheaper.

  • Thomas O.||

    1. Get rid of onerous regulations.
    2. Allow insurance purchases across state lines.
    3. ?????
    4. Profit (from healthcare savings)!

  • hotsy totsy||

    Hell, allow insurance purchases over international borders.

  • Kenner||

    Remove the EXEMPTION to the Sherman Trust Act the health insurance companies have enjoyed since the '50's.

    Yes, the Govt allows health insurance co's to form Monopolies!

    Thx Big Govt...

  • trshmnstr||


    If not, here's a not entirely libertarian approach that would, however, be a step in the right direction. Local city and county government (hell, the states could get in on this too), could offer a tax incentive to doctors and hospitals for each pro bono hour spent treating indigent people. The government could be the administrators by deciding which people qualify as indigent enough and which procedures qualify as expensive enough to be pro bono.

    Beyond that, incentivize catastrophic-only insurance, and get rid of tax incentives to employer-based insurance. Then, set a tax rate of zero on any "critical and life saving" medical practices and manufacturers, all while reducing the regulations that get in the way of devices and drugs coming to market.

  • Emmerson Biggins||

    And ya, that was 100% sarcasm. I guess I got the phrasing right if I got even a nibble on the end of that line.

  • buybuydandavis||


    Stop having to ask permission from the government to treat ourselves and choose our providers.

    "Life, liberty, and the pursuit of happiness."

    These are among the rights the government is charged with securing. Instead, the government controls your ability to heal yourself, taking your liberty, often thereby taking your happiness and even your life.

  • c5c5||


    While it is nice to offer solutions when discussing problems, there is no obligation to do so.

    Pointing out inadequacies and outright wrongs does not require also presenting alternatives.

    Sometimes people just need to be alerted.

  • Auric Demonocles||

    Considering how much of my dating pool seems to be girls who are NPs or in school for it, I approve of any effort to increase their ranks.

  • ||

    I thought your dating pool was limited to the animal shelter. Do they still let you adopt animals after the last...ahem...incident?

  • Auric Demonocles||

    It was pretty easy to get them to blame Sugarfree.

  • SugarFree||

    Damn you. I knew it was you that was fisting all those kittens.

  • ||

    I can't tell you how many people I've met who on the one hand support caps on medical residencies "in the interest of safety," but then believe NPs and PAs should be a resource supplement for physician services. It's absolutely maddening!

  • ||

    What the hell is safe about limiting the number of people that can help treat you in doctor's offices and hospitals?

  • The Late P Brooks||

    Don't worry, everything is under control.

    President Barack Obama will focus on such benefits at a White House event Tuesday. Flanked by Americans who the White House says have gained as a result of the overhaul, the president will try to remind Americans that his health law is preventing insurance discrimination against those with pre-existing conditions and is allowing young people to stay on their parents' coverage until age 26. He'll also take aim at Republicans, arguing that the GOP is trying to strip away those benefits without presenting an alternative.

    Behind the scenes, the administration is furiously trying to rectify an unresolved issue with enrollment data that could become a significant headache after the first of the year. Insurers say much of the enrollment data they're receiving is practically useless, meaning some consumers might not be able to get access to benefits on Jan. 1, the date their coverage is scheduled to take effect.

    We've got our best people on it. It'll be up and running in a jiffy.
    Meanwhile, take a leisurely stroll down the main street of this lovely replica of Rock Ridge.

  • Pro Libertate||

    You know, what he should do is rebrand himself as Buckaroo Banzai. With all of the sidekicks, everyone in full costume and character.

  • ||


    He needs a spiffy uniform with epaulets and a really big hat all with lots of gold trim and enough sparkly medals and ribbons to cover his chest.

  • Pro Libertate||

    From this day on, the official language of San Marcos will be Swedish. Silence! In addition to that, all citizens will be required to change their underwear every half-hour. Underwear will be worn on the outside so we can check. Furthermore, all children under 16 years old are now. . .16 years old!

  • ||

    Heh Heh. Exactly. I was thinking of 'Land of the Blind', but that works.

  • Pro Libertate||

    Same thing.

  • ||

    And he should only give speeches in front of giant, garrishly colored O banners.

  • Pro Libertate||

    I'm thinking some sort of animated Hypno-O.

  • Radioactive||

    maybe a giant poster of him fisting kittens?

  • WTF||

    his health law is preventing insurance discrimination against those with pre-existing conditions

    Paying for someone's pre-existing condition is not insurance, it's welfare.

  • Will Nonya||

    No, no no. They used the D word, so it can't be welfare...

    Everyone knows discrimination is evil, I mean how could we all be equal if we're allowed to discriminate or to charge people fair prices for services rendered.

  • 21044||

    Define per-existing condition.

    Q: Is someone who maintained their insurance for 20 years and is then diagnosed with a genetic condition that previously did not require treatment, is that person collecting welfare?

  • hotsy totsy||

    Nope. And if the insurance company drops him, I think he should be able to get all the money he paid into insurance those 20 years be given back.

    And also, the main problem with health care is it's WAY to expensive.

    A bill from the ER for seeing a baby with a high fever for 15 minutes, listening to his lungs and then sending him home with baby aspirin will run you $1000. So your insurance covers $800. You're still paying $200 AND the damn insurance every month. A nurse practitioner could do it for $150 even without insurance.

    When a friend of mine visited Argentina with her husband and 3 year old daughter a couple years ago, the little girl got sick with fever and flu-like symptoms.
    They called an Argentine doctor who made a HOUSE CALL, gave her something for the flu, and charged them $15.

  • So Conz Esq.||

    will they be wearing hospital gowns? neck braces? arms in slings? in wheelchairs with oversized casts on their legs? I expect cartoonishness.

  • Will Nonya||

    Top. Men.

  • parkerbce586||

    until I looked at the draft that said $8761, I have faith best friend had been actualie erning money part time at their laptop.. there mums best friend has been doing this 4 only about 8 months and resently repaid the morgage on there villa and purchased a brand new Aston Martin DB5. see here now

  • Auric Demonocles||

    Tell me more.

  • Brian D||

    You'd think they could afford a marketing department with people fluent in English.

  • Brian D||

    Then again, maybe that's their secret.


  • PD Scott||

    A brand new DB5? Last built in 1965?

  • trshmnstr||

  • nova3930||

    Anecdotal I know, but about that "no evidence" tell that to my wife's grandmother who's in a wheelchair because the NP had "no idea" you shouldn't drop the blood pressure of an 83 year old to what's considered "normal" for a 20 year old. She immediately had a stroke and has been stuck in a wheel chair for the last 5 years.

    NPs are a fantastic idea for SOME things. Sniffles, sneezes and lots of the acute cases that present no complications are a great idea, but primary care is a lot more than that. When it comes to managing chronic and/or multiple conditions, I think I'll take my doctor with all his extra training.

  • Brian D||

    Fortunately, nobody's suggesting that doctors should not be an option when looking for a primary care provider.

    Sorry about your wife's grandmother though. What's great about the information age is that stories like yours can spread faster and allow people to make better informed decisions about the level of risk they should take for themselves.

  • Invisible Finger||

    Actual MD's do the exact same shit. Doc never changed my Dad's blood pressure med in 30 years, blood pressure lowered and started having organ dysfunction, doc blamed it on leukemia.

  • hotsy totsy||

    Similar with my mom. They put her an warfarin almost as a routine with people in their eighties. Thinned out her blood so much she almost died.

    Another reason I appreciate 23&Me; - they pointed out I had a gene that made me not tolerate warfarin blood thinners very well. I suspect I got it from my mother.

  • Will Nonya||

    Sounds like the medical profession needs a lesson in risk assessment. Train a nurse to know their boundaries and to identify higher risk situations which should be reviewed by a Dr and I don't see the problem.

  • Agreenweed||

    Which is exactly what is happening with nurse practitioners.

  • Overtaxed||

    You know what else would make health care a lot cheaper? Stopping drug prohibition! I've been to the Dr about a dozen times over the past 5 years, each time with only one goal, obtain a prescription for a drug that I already knew what I needed/wanted. I walked in, talked to the Dr, and they wrote me some scripts. Probably cost my insurance company a few thousand dollars a year in Dr costs (because often I need a script on an emergency basis because of an injury) simply to get a pill. Madness.

    If you could walk into your local pharmacy, talk to the pharmacist and get "permission" on the spot for drugs, I'm not sure I would have seen any doctors at all over the past decade. They are gatekeepers for the drugs that work, take that from them, and see the volume of patients drop dramatically (and, probably better for everyone, since now they will see people who actually need something more than a permission slip!).

  • SQRLSY One||

    Prescriptions for drugs? That’s not even the worst of it, I expect to need to get a prescription to scratch my own butt-hole, any day now… Lots of delicate tissues down there, you know, and an ignernt, medically un-edumacated moron like me might hurt myself w/o a prescription… See “lung flutes” (see and use “lung flutes” as a search-string), along with “ear-poppers”, as examples of, of anyone ever invents anything new, that might have the vaguest potential of being called a “medical device”, no matter how trivially silly and harmless, the FDA will want to over-regulate it and make me get a fuckin’ PRESCRIPTION for it!!! Then they tell me that Government Almighty is the one to look to, to lower medial costs! Fuckin’ assholes, all of them! When do we get to start shooting the bahstahds?


    Did anyone else understand his mechanic analogy?

    I felt like a wut blurb would have been extremely appropriate.

  • Agreenweed||

    That was one of the poorest analogies I have ever heard, hands down.

  • Michael S. Langston||

    This wouldn't be such a big deal, nor would doctors or nurses opinions be all that valuable if we had anything approaching a free.ish market wrt health insurance.

    As those who want/need (for medical reasons making them an outlier) could purchase a guarantee of a doc every time. For those not needing it, could purchase alternate forms.

    But alas, even pre o-Care, health care was regulated to such an extent, that many thing wrt to what a doctor can do, what a nurse can, what a RN can, versus LPN, doc assisted, etc, etc - are legal battles by virtue that the current status quo is setup by law to be that way.

    Additionally whatever current status quo is has a set of people who are protected within it and likely don't want it to change a great deal. Conversely others want only new power, but continued restrictions for anyone else.

    As don't let RNs fool you on this "we care" crap - they went on strike in several hospitals for proposing that it didn't require a 4 year BS in Nursing to draw blood. That was almost 20 years ago - today it's considered obvious that an RN degree is not required to draw blood.

    I assume as RNs are seemingly pro-union over the past 20 years or so, Obama is going to be looking for ways to save money, RNs want more power/money (don't we all) - this seems like a perfect thing to try to get accomplished under the current administration and given the current political climate.

  • Agreenweed||

    Hey that RN union strike bullshit might happen in California but none of the hospitals I work at have had it.
    Try being a waitress, not getting tips, keeping someone from dying, giving them live saving medications, missing your lunch because your patient is more important than yourself, then cleaning anywhere from 2-20 shits in just one night (I've gotten pretty close to the 20). You may want a few more dollars an hour then, too. Oh, and don't forget about the asshole doctor that is mad at you for calling him at home about the patient who is sick as hell.
    That said, striking as a nurse would jeopardize patient care. Though I think workers should have the right to organize and to push or bargain for better benefits, I think unions tend to take things too far and too often turn to political interest groups.

  • mtbwalt2||

    Nursing unions constantly strike in Philly.

  • Agreenweed||

    Oh, and by the way, the majority of RN's have associate degrees, ie AS, not BS, especially 20 some odd years ago.

  • flashgordon||

    Great article. The AMA is the union for MD's. The University of Chicago economics department flagged the AMA limiting the number of medical schools to keep MD incomes high in the 50's. Ask yourself, why shouldn't any major college you've heard of have a medical school? I give San Diego State as an example. This NP is a way to really fast track true market competition in the medical arena which is great. Guess the AMA overreached. They made it really expensive, now we are mostly going to get socialized medicine (Obamacare), and I guarantee one of the things these Obama regulators isn't going to worry about is preserving the MD 150/yr income.

  • OneOut||

    Only about 30% of Drs belong to the AMA.

    ( according to my Dr )

  • mtbwalt2||

    Under 15% of doctors are in the AMA.

    THe are mostly the resident trainees who get free membership and are so so tickled to be called a doctor.

    The AMA is not a union for doctors. It is a self-serving body that sells CPT codes and similar administrative services directly to the government for money.

    The AMA supported Obamacare over the vast disapproval of physicians. Their money comes from government, not docs.

  • OneOut||

    1. double or triple the number of medical schools
    2. allow a clinical setup where a doctor has 2,3, or 4 NPs screening patients for colds and bo bos and clearing their decisions with the Dr. Dr has legal liability so he hires the best NPs and monitors them.
    3. sell insurance across state lines
    4. tort reform ( Texas did it and we have a 60% increase in applications to practice here
    5. pre tax health savings accounts
    6. allow individuals who buy their own insurance the same tax advantages that business' have

    O'care is going to kill the innovation of medical treatment that is the hallmark of the US heath care system. The desire for potential profit is what drives advanced medical techniques and procedures. ( with a few exceptions )

  • OneOut||

    Oh Yeah

    7. allow Medicare to accept people with pre existing conditions with proper and reasonable rules that prevent people from gaming the system.

  • mtbwalt2||

    A couple of points:

    1. The "literature review" indicating that NPs are as good as docs is a false equivalency. It includes a few very basic things that show NPs are just as good as physicians - in extremely specific circumstances like treating runny nose in an outpatient pediatrics setting during the month of July in Philadelphia. This is "literature" jury rigged and written solely by NPs to try to establish general equivalency to physicians based on silly basic presentations. A freaking trained monkey could do the same thing. This kind of "research" makes the climate change scientists look ethical and reasonable. Docs don't publish papers establishing that neurosurgeons are better than NPs at brain surgery because it is so fecking obvious.

    2. Really, if you are going to dumb down to the point of an NP, we should design a system where people can just self-diagnose and treat. Patients would honestly do a better job themselves. You could research your symptoms with Watson, order some lab tests, confirm the diagnosis, and self-treat. I guarantee that most patients would be better served by this than contracting an amateur who makes brash assumptions out of ignorance and the knowledge that most illnesses are self-limiting.

  • OneOut||

    So Doctor

    Tell us more why you are against Nurse Practitioners ?

    Look..seeing a NP is better than not seeing anyone at all, and that's what it is coming down to.

    Maybe if there were more of you , you wouldn't feel like you are so special?

  • mtbwalt2||

    I am not against nurse practitioners. They can do whatever they want as far as I am concerned. My subspecialty is way beyond what a nurse can perform, so I don't personally have a turf issue with them.

    People who go to them for care should expect to receive care based on their training as nurses. If suckers choose to go to them expecting care similar to what a physician provides, they deserve what they get.

    For example, a nurse treating someone for stomach ulcers has probably never heard of Zollinger Ellison syndrome or a host of other disorders that predispose to stomach ulcers. Whereas a physician has these things floating around in his or her mind during a treatment course, and will recognize patterns of disease based on the interconnected webs of medical knowledge, you can expect a nurse to just treat the ulcer and hope for the best. You could really do a better job yourself if you are capable of doing a google search, and if the government allowed you to order your own lab tests.

    When I speak to a physician about a condition, they usually understand what I am talking about. When I speak to an NP, they are frequently clueless and waay over their heads. Like talking to a 6th grader about partial differential equations.

    If people want to be taken in by false marketing of NPs as equivalent to docs, then go for it. With dramatically lesser credentials required to become an NP and with dramatically lesser training, caveat emptor.

  • gimmeasammich||

    How rare is Zollinger Ellison syndrome? "If it saves just one life..."

    Nobody is saying NPs are equivalent to doctors. A lot of things people see the doctor about aren't that complicated. Why is it so ludicrous to think that one or two doctors can't oversee dozens of NPs by reviewing their notes and intervening when necessary? Most people at least have an idea when something seems routine and when it requires a more knowledgeable person. The NP should know to take decent enough notes. This system *should* only get more efficient with time.

    There are also doctors who aren't worth their salt as well. Do you know what you call a guy who finished dead last in med school?

  • Agreenweed||

    Funny thing, as a practicing nurse (who has spent much time in a neuro surgery intensive care, just for added irony), I regularly see how doctors' egos influence decisions. The "I'm the man, I know all" complex is just astounding and it seems to be widespread among doctors I have worked with. Its not the least bit surprising that MD's feel threatened by the very existence of nurse practitioners. Oh, and hey, you should know-not only do NP's not do surgeries (sure, they can be first assists in surgery, but that is different), but as far as I know, the NP's are making no effort to become surgeons of any type, much less brain surgeries, so your NP vs brain surgeon analysis is piss poor. Another thing for you to keep in mind that in only two years of nursing, I have likely spent as much time with patients at the bedside than a doctor spends with his patients in decades.

  • mtbwalt2||

    Docs definitely engage in rent seeking behavior.

    NPs attempts to promote general equivalency based on very small focussed studies are equally silly.

    My NP vs neurosurgeon example was to illustrate that NPS who show equivalency in one small, focused situation and attempt use that to suggest general equivalency to physicians in general engage in flawed reasoning.

    Some MDs may be arrogant, or be perceived as arrogant based on knowledge. However, it is equally a false comparison to suggest that in 2 years you have spent more time with patients then a physician spends in decades. Much of your time is spent charting and at nurses stations, and only a small fraction is spent actively evaluating patients. Physicians often have offices where they see and treat patients all day, every day. Also, you may cover 6 patients, but a rounding physician may be covering 40, and so spends less time with each individual patient. So please, save the "I spend more time with patients than doctors by an order of magnitude" line for the politicians and rubes.

  • TimothyZ||

    "NPs attempts to promote general equivalency based on very small focussed studies are equally silly."

    That's not as fair minded as you like to believe. Even if they were seeking to paint a 'general equivalency', which they are clearly not, it's not the really dangerous mistake here.

    The problem is the diversion of resources inefficiently. Legally prohibiting competencies that are well withing the reach of trained professionals is absurd, and it is the law.

    These are not equipotent fallacies.
    Do security guards make the wrong call sometimes? Yes, but they are also better able to recognize a situation where the police would be warranted than if no one is on watch. Could a bouncer make a wrong call and get someone needlessly injured. Sure. But then, private security a multi-billion dollar business: because of the results.

    Do you need a medical degree to cope with routine medical situations where delayed intervention would be foolish? Ask your mother.

    I see, with my own eyes, too many elderly people waiting too long for care. Just wait till they old, those busybodies, those qualification mongers, destined for their own damned queues.

    But luckily for us, the world ain't waiting on 'em.

  • hotsy totsy||

    If prescription drugs were easier to obtain this would be feasible. But the medical establishment doesn't approve of people even looking at their own lab tests, never mind ordering them.

    Not necessarily individual physicians, but the medical unions, like the AMA, and government agencies like the FDA, want to have a kind of priesthood of physicians and bureaucrats who have the power of life and death over the health of individual citizens. You don't own your own life, they do.

  • mtbwalt2||

    Agreed. I think almost all drugs should be OTC. Perhaps some things like chemotherapy should be the exception.

  • Radioactive||

    when you think about it everyone in medical business is a trained monkey...some just get different training than others

  • Libertarian Barbarian||

    This could solve so many of our health care woes. IF, and I do mean IF, we have to subsidize health care for low-lifes i.e. the uninsured, old, and poor "people" then sending them to the cheaper nurse practitioners would save us billions of dollars not to mention the reduced wait times I have to suffer through because these medicaid scumbags are hogging up the doctors available time. I've got shit to do people!

  • Agreenweed||

    You can fall in right behind all the indigents, my friend!

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    my neighbor's mother makes 63 BUCKS every hour on the laptop. She has been out of work for 7 months but last month her pay check was 15302 BUCKSjust working on the laptop for a few hours. Learn More Here

  • InklingBooks||

    Perhaps my experience will help. I was once on the nursing staff caring for children with leukemia. One risk of treatment is tumor lysis syndrome (TLS). Medical texts say it's diagnosed with a blood chemistry test. That fits with MDs training. An out-of-line blood chemistry after first-time chemo is almost certainly TLS.

    But for actual care, that near-perfect clinical diagnosis isn't what's needed. Hospitals aren't going to run a blood chemistry every two hours. They need to know 'Something's wrong. Run tests."

    That's precisely what I did. About 3 a.m. I noticed one of our new patientsnabout halfway through his initial chemo, was behaving odd. The resident noticed nothing but I persuaded him to run a blood chemistry. When it came back, the boy was rushed to the ICU. It was TLS and within days the national protocol was tweaked for situations like his.

    The lesson? Perhaps physicians are trained a bit too much in looking for diseases and not enough at looking at patients in their totality. That's perhaps why nurse practitioners perform as well as MDs in real life.

    --Michael W. Perry, author of My Nights with Leukemia: Caring for Children with Cancer

  • steve8229||

    Google is paying 75$/hour! Just work for few hours & spend more time with friends and family. On Sunday I bought themselves a Alfa Romeo from having made $5637 this month. its the best-job Ive ever had.It sounds unbelievable but you wont forgive yourself if you don’t check it out

  • Dantes||

    A Health Affairs Survey is hardly scientific proof. Not peer reviewed, and you will note that there are no physicians on the paper.

    I am a radiologist. If you believe that NP's are equivalent to doctors, with 2 years of extra training after nursing school or less, compared to physicians with a minimum of 4 years post MD school training, then we are overtraining doctors.

    Patient satisfaction surveys are hardly a measure of competence.

    Another problem NP's have, and what their poorly designed, self serving studies showing that care provided by NP's is the same as doctors, is what I call the "wheat and chaff" problem. Take 100 random people who see a doctor or NP for care. The chances are good that whatever illness they have is not could prescribe eye of newt and the patients would likely get better.

    They are blissfully ignorant of the pitfalls and traps in medical care.

    If they don't know their own limits, and their response to doctors is to screw off, you just don't like the competition, which seems to be their knee jerk response...well, let the buyer beware.

    As a radiologist, from a purely financial standpoint, NP's are fine with me. They order far more radiology exams than doctors.

    This is a poorly researched piece which buys into a lot of nonsense, and is unworthy of Reason magazine.

  • InklingBooks||

    Education and skill aren't the same thing. Physicians get more education, but that does not translate into more skill. Skill is willed. It's thinking constantly, questioning everything, and learning from mistakes. A nurse practitioner who does that will be better than a MD who goes through the motions.

    Years ago, I received EMT training at a community college. That got me a night-shift position working with a nurse on the Hem-Onc unit at a top children's hospital. I realized that, if any of my patients got into trouble, I was their only hope because only I interacted with them..

    I circulated among constantly, checking, and honing a sixth-sense to tell me a child was in trouble. Twice, I had to push a more educated but less skilled resident to stop chemo or run a test. Within hours both kids were in the ICU.

    Note that I had no formal education in cancer, yet I became skilled. Over 26 months and some 4000 hours, I never made a mistake that led to an incident report. Keenly aware that a failure on my part could lead to a child's death, I drove myself constantly to acquire skills.

    A nurse practitioner who does that will beat the socks off a physician who has too much confidence in his formal education. And I recently wrote up my experience in a book for nursing students.

    --Michael W. Perry, My Nights with Leukemia: Caring for Children with Cancer

  • Clevis||

    I support NPs as primary care providers but the cost savings will be temporary.

    This is a predominantly female profession who will realize that they are being paid less than their more often male MD colleagues for doing the same job (and getting the same results).

    This will be a clear case of sex discrimination, at least by overwhelmingly disparate impact, as women will be paid less than men for doing the same job.

    Besides the class-action suits against private insurance companies, Medicare payments will be altered to adjust for this by demands of politicians who need the "woman vote".

    NP payment rates will be adjusted to that of MD payment rates and POOF!, any cost savings will vanish.

  • ALittleAngry||

    Seems like a hit piece on MD's, with little 'reason'ing. For instance:

    Even though it was one of the themes of the article, the author never shows just how the NP delivers care less expensively. Does she bill insurance or charge out at a lower fee than an MD for the same procedure? If so, how long do you think that is going to last?

    Ms. Doyle stated at the beginning that she wanted to utilize a "nursing model" rather than a "medical model" to deliver care. What the heck is the difference between the two and does it translate into reduced cost for consumers?

    If an LVN were to suddenly be licensed to perform 30% of a NP's core practice, do you think the Nurse Practitioner's Association would fight it?

    Finally, Ms. Doyle states "Nurse Practitioners are making physicians a lot of money", and "we don't think we're trying to take over your job, we want to work in conjunction with you". Translation: we want a bigger piece of the pie and we will utilize the legislature to achieve it.

    How is than any different from physicians?

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