For Primary Care, can an NP ever be as skilled as an MD?

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Perhaps after years (or decades) of practice, do you think an NP can be as skilled in providing primary care as an MD? Or will the NP forever be lacking something for not going to medical school?

Specializes in Emergency medicine.
On 6/25/2019 at 3:13 PM, myoglobin said:

The more relevant question is "can NP's achieve the same or better outcomes as an MD" and there are studies to suggest that they in fact accomplish this. More knowledge doesn't always equal better outcomes.

I would add that there are many different attributes that make someone a skilled clinician, and the studies you mention weren't designed to detect anything less than big differences in major health outcomes, and with major confounding factors. The conclusions drawn by many people after those papers aren't well supported by the studies themselves.

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10 hours ago, TuxnadoDO said:

I would add that there are many different attributes that make someone a skilled clinician, and the studies you mention weren't designed to detect anything less than big differences in major health outcomes, and with major confounding factors. The conclusions drawn by many people after those papers aren't well supported by the studies themselves.

Another reason why NPs could benefit from a true biostats class and real research courses. The "studies" measuring these chronic conditions (which are all heavily algorithmic at this point so I wouldn't be surprised if I handed a high schooler a flow chart if they couldn't have similar outcomes) and showing NP and MD equivalency are incredibly biased, poorly designed and ultimately heavily biased towards the null. Conclusions can't and should not be drawn from them.

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Specializes in ICU, trauma, neuro.

My point is that NP’s can produce at least roughly equivalent outcomes at lower cost and will eventually supplant physicians in primary care. Indeed, I believe the superior outcomes are in part due to closer alignment with algorithms and also more holistic approaches. Indeed, as AI assisted expert systems for diagnostics and treatment become more widely used this will become even more the case.

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1 hour ago, myoglobin said:

My point is that NP’s can produce at least roughly equivalent outcomes at lower cost and will eventually supplant physicians in primary care. Indeed, I believe the superior outcomes are in part due to closer alignment with algorithms and also more holistic approaches. Indeed, as AI assisted expert systems for diagnostics and treatment become more widely used this will become even more the case.

Lower costs except that most np organizations are doing more than fighting for expanded practice. They're fighting for equal pay for equal/similar work. Which means in the long game we won't be saving anyone a dime.

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Specializes in ICU, trauma, neuro.

Even with equal pay (rather than the 85% reimbursement that is common) they might still be cheaper. Consider, that it is reasonable to graduate from NP school with less than 50K in debt at the age of say 26 whereas the typical MD will be closer to 30 with well over 100k. That means they are in a better position to "allow more time" for patients since they have less debt to service. Even with my staggering 160K in student loan debt, and being 50 I'm still seeking a situation where I can earn about 150K per year and have 30minute appointments in an IP state. If my son follows in my footsteps (debt free) he might be happy to earn 80 or 100K facilitating longer appointment times and less stress.

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Few to No NPs in any climate will be *happy* to make 80 to 100k. By the time the next generation is in this spot cost of living alone will make this career financially worthless if pay goes down like that.

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Specializes in ICU, trauma, neuro.
34 minutes ago, djmatte said:

Few to No NPs in any climate will be *happy* to make 80 to 100k. By the time the next generation is in this spot cost of living alone will make this career financially worthless if pay goes down like that.

Perhaps you are correct, but they will surely be more likely to work for less than MD's if they can be educated for less, have less in student loan debt, and do it in far less time. I for one would be quite content with 100K per year ONCE, my student loan debt is paid off and I'm someone who considers myself "in it for the money" (at least to a significant extent). I also have no IRA, no home, or other savings, and yet I would still be content with this amount.

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Specializes in Emergency medicine.
7 hours ago, Dodongo said:

Another reason why NPs could benefit from a true biostats class and real research courses. The "studies" measuring these chronic conditions (which are all heavily algorithmic at this point so I wouldn't be surprised if I handed a high schooler a flow chart if they couldn't have similar outcomes) and showing NP and MD equivalency are incredibly biased, poorly designed and ultimately heavily biased towards the null. Conclusions can't and should not be drawn from them.

I could hug you for this.

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Specializes in ICU, trauma, neuro.
7 minutes ago, TuxnadoDO said:

I could hug you for this.

Well Cochrane isn't known for publication bias in favor of nursing https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001271.pub3/full and they seem to favor at least parity in outcomes in this meta-analysis. Of course future studies may reach different conclusions. What cannot be argued is that NP's can be trained faster, and with less expense than MD's. It it logical that with increasing burdens on healthcare in terms of population dynamics, immigration, and an exploding public debt that NP's in primary care settings are one solution. Don't worry though, within a hundred years (on the outside) we will all be replaced by are AI enabled robotic overlords.

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We use an NP as a primary care provider for all of our kids, the two healthy "easy" ones, and my medically complex/medically fragile/technology dependent one.

My complex kid joined our family through adoption, and so we had to think carefully about whether we wanted to use the same provider, vs. a doctor in the same office, or a different practice. In the end, we decided to use the same person for a few reasons. For one thing, the things that we valued the most about her, like the fact that she really got to know our boys, and the fact that she listens carefully to us and them were even more important with our complex son. But even more importantly, we don't make any medical decisions for him without involving specialists, and partnering with doctors is one of the things that NP's do best. She's always willing to take that phone call, or listen to me explain the care plan. In comparison, we've had experiences with doctors where we asked to talk to a specialist, and they took umbrage, or claimed they didn't have time. Now, I'm sure there are NP's out there who might be the same way, but we haven't encountered them yet.

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1 minute ago, nursenmom3 said:

We use an NP as a primary care provider for all of our kids, the two healthy "easy" ones, and my medically complex/medically fragile/technology dependent one.

My complex kid joined our family through adoption, and so we had to think carefully about whether we wanted to use the same provider, vs. a doctor in the same office, or a different practice. In the end, we decided to use the same person for a few reasons. For one thing, the things that we valued the most about her, like the fact that she really got to know our boys, and the fact that she listens carefully to us and them were even more important with our complex son. But even more importantly, we don't make any medical decisions for him without involving specialists, and partnering with doctors is one of the things that NP's do best. She's always willing to take that phone call, or listen to me explain the care plan. In comparison, we've had experiences with doctors where we asked to talk to a specialist, and they took umbrage, or claimed they didn't have time. Now, I'm sure there are NP's out there who might be the same way, but we haven't encountered them yet.

As an NP, I will take a bow for the team. Thanks, and I only see an MD when there is no other choice.

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Just now, Oldmahubbard said:

As an NP, I will take a bow for the team. Thanks, and I only see an MD when there is no other choice.

Thank you for what you do!

Now, I've probably jinxed myself, and the next NP we get in the ER will be a jerk. If so, I'll come back and report! ?

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