Originally Posted by Josh L.Ac.
Where is the evidence that medicine is male-dominated and therefore physicians make more than women nurses? Sounds like the biased, unscientific claims made in my Graduate Nursing Theory book...or assumption, if you will.
And finally, once again, the burden of proof is in the claimant, meaning it is the responsibility of nurse practitioners to show they are as good of practitioners as physicians, not the other way around. Aside from research that showed that nurse practitioners that were supervised by physicians were possibly as good as residents, there is none.
A real patient advocate would demand good research to show that solo nurse practitioners are not causing harm to the patients and function as well as physicians.
Keep in mind that Nurse practitioners are educated to provide primary care.
There is research that shows that NPs provide a valuable service that is comparable to pysicians and is also cost effective.
http://www.rwjf.org/reports/grr/032806.htm
SUMMARY
From 1998 to 1999, researchers at the Columbia University School of Nursing conducted the second phase of a study comparing nurse practitioners and physicians as primary care providers.
During Phase I, researchers assigned patients randomly to either a nurse practitioner or a physician at Columbia Presbyterian Medical Center. Researchers had found no significant differences in the health status or health services utilization of patients in the two study groups, after one year.
To see if the findings were maintained over an additional year, in Phase II of the study researchers collected additional data through 756 patient interviews (439 with the nurse practitioner group and 318 with the physician group).
Key Findings
Patients who were assigned to nurse practitioners were similar demographically to patients assigned to physicians.
In the year before this data collection:
Thirty-three percent of patients received care only at the assigned clinic.
Six percent received care at the assigned clinic and another provider.
Twenty-seven percent only sought care elsewhere.
Thirty-two percent did not seek primary health care at all.
Researchers concurred with the preliminary results: in an ambulatory care situation where nurse practitioners have the same authority, responsibility, productivity and administrative requirements as physicians, patient outcomes are comparable.
Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $162,075.
See Grant Detail & Contact Information
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THE PROBLEM
Assuring adequate access to health care for all segments of society continues to be a major challenge for policymakers and the health care industry. NPs serving as primary care providers have the potential to improve access to care, but there was a lack of definitive data on the impact of NPs in this role.
Columbia University School of Nursing assumed a leadership role in advanced nursing practice in 1994 with the opening of the Center for Advanced Practice, a nurse practitioner primary care clinic, one of six community-based primary care practices maintained by Columbia Presbyterian Medical Center.
It serves a primarily Hispanic Medicaid population of more than 3,200 adult and pediatric patients in the Washington Heights-Inwood section of Manhattan. It is staffed by faculty nurse practitioners who have been granted hospital-admitting privileges by the Medical Board of the medical center.
During Phase I of this project, the Columbia University School of Nursing conducted a randomized study to compare NPs and MDs as primary care providers. This study, conducted from August 1995 to October 1997, was entitled "The Evaluation of Primary Care in Washington Heights." It was funded by the New York State Department of Health, the Division of Nursing of the US Department of Health and Human Services, and the Leslie Samuels and Fan Fox Foundation.
The study enrolled 1,316 patients who were referred from two emergency departments and one urgent care center at Columbia Presbyterian Medical Center. These patients were assigned randomly to either a nurse practitioner (806) or a physician (510) at Columbia Presbyterian Medical Center.
Baseline data included the patients' functional health status and whether they had one of three chronic conditions targeted for study: asthma, diabetes, or hypertension. Patients were interviewed six months after their initial appointment and health services utilization data were recorded at six months and one year after the initial appointment.
As reported in The Journal of the American Medical Association (JAMA), no significant differences were found in the health status of patients who saw nurse practitioners and those who saw physicians. No significant differences were found in health services utilization after six months or one year. Following the initial appointment, there were no differences in patient satisfaction with primary care. At six months, satisfaction ratings differed only for provider attributes, with physicians rated slightly higher (4.2 vs. 4.1 for NPs on a scale where 5 equals excellent).
The researchers concluded that patient outcomes were comparable in an ambulatory care situation in which patients were randomly assigned to either NPs or MDs, and where NPs had the same authority, responsibilities, productivity, administrative requirements, and patient population as MDs.
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