This article touches on the third rail in healthcare but I think it’s worth explaining why replacing doctors with non-doctors doesn’t work. Let me preface this by saying no other profession has to deal with these ridiculous comparisons. Legal assistants are never thought of as lawyers. Flight attendants are never thought of as pilots. Not so in our broken healthcare system. In an attempt to save money, hospitals jumped on the many fraudulent studies that purportedly showed that non-doctors can do the same work as doctors. Those studies were all done with SUPERVISED nonphysician practitioners (NPPs).  I refer you to this article by Natalie Newman, MD.

In the case of NPPs, THAT HAS NEVER BEEN PROVEN. Ever. PAs have no studies, as they are required in the majority of states to be supervised–by law. NPs spout studies from 20-plus years ago that involved supervised NPs, thereby making those studies non-relevant to today. 

Want more proof? 

Recently a 3-year study of NPs in the ED, using compiled data from the Veterans Health Administration(VHA), was published by the National Bureau of Economic Research(NBER). Conclusion: NPs increase lengths of stay by 11% and raise 30-day preventable hospitalizations by 20% compared with emergency physician. The data period encompassed 2017-2020, the time in which NPs have been practicing without physician supervision or “collaboration” at the VA. I have stated for years that a follow-up study evaluating the quality of care and use of resources needed to be done in states in which NPs have had unsupervised practice for years, such as Oregon, Washington and Arizona. I hold the opinion that none of the nursing organizations, including the American Association of Nurse Practitioners(AANP), will ever perform such a study because they would find exactly what this working paper and the Hattiesburg study found, that NPs do not provide cost-effective care, they overutilize ancillary services such as laboratory and radiologic resources and the care they provide is not equivalent to that provided by physicians.

I will get blowback from the militant wing of the AANP even for writing this but it has to be said. Patients come first. Always. 

Yet hospitals are still trying to get rid of doctors.  Here’s a recent example:

Providence Sacred Heart Medical Center will lay off eight physicians caring for psychiatric patients in a move anticipated to save between $2 million and $4 million and help the hospital’s health care workers meet a need in the community beyond its doors.

And how are they going to help patients? “Sacred Heart also plans to hire three advanced registered nurse practitioners to the staff that will serve psychiatric patients.” This is not acceptable but it is a reality. 

This article is not about denigrating NPPs (nonphysician practitioners). After removing the degree mill phonies you find that most of these are highly educated people who have a role in our healthcare system. That role, however, is NOT in replacing doctors. 

If you are an administrator who is thinking about following the Sacred Heart’s example then heed this warning. Doctors who work for you will start looking for jobs elsewhere. You will also have very little luck recruiting other physicians to come to a place where they are not valued. Your ability to retain your doctors will be sabotaged. No program, liaison, or physician lounge will help. 

There are other ways to save money. Getting rid of physicians is not the answer. It will cost you more in the long run while also worsening the care your patients receive. 

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