4 ms·

There is some evidence in the primary care world that going to a NP for primary care costs more than going to a doctor: https://www.ama-assn.org/practice-manage

There is some evidence in the primary care world that going to a NP for primary care costs more than going to a doctor: https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope https://www.ama-assn.org/practice-management/scope-practice/.... In short, NPs order more tests without improving patient outcomes. I have no doubt that it's the same in the ER. It takes training and knowledge to know what test you don't have to order. Do you really need a CT scan for your diarrhea? That being said, I think there is definitely a role for NPs : low complexity and/or non-acute highly specialized care. The emergency department is not the environment for that.

tyoma 4y ago
Is it though? There are quite a few people who lack access to the normal healthcare system and use the ER as primary care of last resort because no one is turned away. PAs and NPs would be perfect for those patients.
mikeyouse 4y ago
The AMA probably isn't the best source for that type of data. The little throwaway lines in that review are funny; "Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety." Weird because the study they're talking about didn't say a word about patient safety. Their metrics are weird too - it's looking at hospital spend "per member per month" which was higher with the non-physician staff but I'd be curious if the $30 difference was more or less than the difference in salaries between the two groups.
- oaktrout 4y ago
  The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.
  - mikeyouse 4y ago
    Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000/Drivers_of_Cost_Differences_Between_Nurse.13.aspx https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000... "Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ For a few examples from the past couple years.
    - seattle_spring 4y ago
      It is a bit rash, but it’s the exact same study trotted out literally thousands of times by disgruntled residents on Reddit, fuming that there exists a profession that can practice medicine without years of humiliating residency. Whenever someone uses that study as a citation, it’s immediate reason to discredit anything else they’re going to say. Just spend a few minutes looking at that “Noctor” subreddit the guy shared. It makes me disguised with MDs in general just reading it, until I remind myself that most of the posters there are just inexperienced students or residents. I do feel bad for the suckers that take its content at face value though.
      - oaktrout 4y ago
        Truly reddit is a place full of idiots on all sides, do you have specific criticisms of the study I posted though? Or specific criticisms of the study in the NPR article?
        seattle_spring 4y ago
        https://xkcd.com/882/ https://xkcd.com/882/

tyoma 4y ago

Is it though? There are quite a few people who lack access to the normal healthcare system and use the ER as primary care of last resort because no one is turned away. PAs and NPs would be perfect for those patients.

mikeyouse 4y ago

The AMA probably isn't the best source for that type of data. The little throwaway lines in that review are funny; "Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety." Weird because the study they're talking about didn't say a word about patient safety. Their metrics are weird too - it's looking at hospital spend "per member per month" which was higher with the non-physician staff but I'd be curious if the $30 difference was more or less than the difference in salaries between the two groups.

oaktrout 4y ago
The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.
- mikeyouse 4y ago
  Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000/Drivers_of_Cost_Differences_Between_Nurse.13.aspx https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000... "Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ For a few examples from the past couple years.
  - seattle_spring 4y ago
    It is a bit rash, but it’s the exact same study trotted out literally thousands of times by disgruntled residents on Reddit, fuming that there exists a profession that can practice medicine without years of humiliating residency. Whenever someone uses that study as a citation, it’s immediate reason to discredit anything else they’re going to say. Just spend a few minutes looking at that “Noctor” subreddit the guy shared. It makes me disguised with MDs in general just reading it, until I remind myself that most of the posters there are just inexperienced students or residents. I do feel bad for the suckers that take its content at face value though.
    - oaktrout 4y ago
      Truly reddit is a place full of idiots on all sides, do you have specific criticisms of the study I posted though? Or specific criticisms of the study in the NPR article?
      - seattle_spring 4y ago
        https://xkcd.com/882/ https://xkcd.com/882/