Quote from wildmountainchild
Whoa Caldje....a bit angry are we? Maybe it's been a while since you took statistics but if your sample population is chosen carefully in regards to control parameters, and remains smaller than 10% of the population being studied, statistically relevant data can be obtained. Over 700 patients is more than enough to represent the populaiton at large (do you think they poll every single person in the U.S. when they do political polls? No, they poll between 500-1000 people and get amazingly accurate results)
I don't even remember the last time I saw an actual Dr., NP's are the standard of care with almost everyone I talk to.....and we are all very, very impressed w/ the care we get.
And...you are reading the study incorrectly, possibly due to your unfamiliarity with statistics. The study couldn't find statistically significant differences because there WERE NONE. The patients were controlled for the type of illnessess they were presenting with, the MD's were not getting the more complex cases. This is clearly stated in the article.
I think the question is less about the validity of the study and more about what you have to lose if NP's are treated as medical professionals.
Actually you are reading the study incorrectly. The study compares the care of MD's and NP's. It finds there were no measureable differences in the sample or health outcomes. However, the most telling part of the study is here:
Due to the small sample size, the researchers had a limited ability to detect statistically significant differences between patients randomized to the nurse practitioner and physician practices.
This study has already been extensively dissected. The biggest problem is the sample size. 1300 patients is less than the panel of one FP physician. This is spread across an unknown number of providers. If there are 10 providers you are measuring less than 10% of the patients (the current website for the NP group lists 4 providers). This is further diluted by the amount of patients that actually saw the provider. It actually deals with only 600 or so patients. That is not enough to get any good data. For example to look for a blood glucose difference of 10 in the diabetic population a total of more than 80 patients are needed. They did not give the number of patients that this parameter was looked at, but it has to be less than this number. The disappointing part is that they did not report any of the statistical data. I would guess it is because they did not have sufficent power to measure any parameter. The parameters for peak flow for example would be much larger since the standard deviation is much larger.
Other problems with this study are:
1. Funding was by the Columbia school of nursing - the entity being studied.
2. The NP's in the study are all senior faculty members of the Columbia School of Nursing. Hardly a "normal population". Average experience is 19 years.
3. There were other significant limitations of the study including the transient nature of the population and the overall health status of the patients which is not described.
It is a shame that this study was published. The Robert Wood Johnson Foundation usually does a better job than this. One of the NP's is a former RWJ fellow so that may explain some things.
This should have been titled "NP faculty at Columbia School of Nursing show no different outcomes versus MD's in a small patient sample". This is a long way from compareable.
Another problem in evaluating NP services is that in New York NP practice must be preformed in collaboration with a physician. It is hard to differentiate what portion of the care can be attributed to what provider.
If NP's are an extension of the physician then this debate does not make any sense. Any advantages or disadvantages would be attributable to the system. Here the proper test would be the difference between MD/NP practice and MD only practice. If you believe that NP's as independent providers are the equivalent or better than a physician you would have to structure this differently. You would have to find a number of NP's that practice independently and find a compareable group of MD's. You would have to match for patient demographics and health conditions. An urban environment such as NYC is a poor place to do this. Either a health care system such as Kaiser with a good data collection system or more likely a rural environment like an AHEC would be idea.
The main problem is that there is no good data that independent NP practice is equivalent to physician practice. There is poor data that NP practice in other environments is not worse than physician practice.
David Carpenter, PA-C