Many great points in this thread. I definitely agree that physician education and training is superior to NPs'. It always astounds (read: embarrasses) me when NPs or PAs compare themselves on equal footing as physicians. Then again, I'm not pursuing independent practice. I know my limitations.
However, there is an imbalance in the amount and often, dare I say, quality of actual work performed. I follow guidelines, perhaps a little too cookbook-y at times, but whereas my physician peers are throwing a z-pack at every URI that walks in the door, I'm only giving antibiotics when they are actually indicated, and then I'm preferentially giving amox-clav. Whereas the physicians don't document PMH, PSH, fam hx, etc, I do. It's never fun when you see an established patient and they casually reference their kidney transplantation which has never been documented in the chart of years of being seen at this clinic. My physician peers also aren't diligent about preventive care screenings. They're not ordering enhanced imaging or genetic testing for women at high risk for breast cancer (nor would they even know bc they don't ask about family history), no lung cancer screening CTs, they're not following pap guidelines, not recommending HPV vaccines, no hep C screening, no PPSV for diabetics, no AAA screenings for smoking history. I am so diligent about these low hanging fruits and make sure it is ALL done. When I look at their documentation I can't help but roll my eyes. I refuse to believe they are performing fundoscopic exams on all of their PEs. Last month I found a rather large thyroid mass during a PE, turned out to be cancer, and the patient later told me in all the years she has been seen by Dr. X he had never checked her thyroid. Oh, but he's doing fundoscopic exams? Please. And yet, I get paid 15% less, for doing more.
I concede that they are better qualified to handle more complicated cases, but I would bet a paycheck that NPs actually perform better than physicians on preventive care. Which is supposed to be our wheelhouse right? So, with such a push for preventive care, I think that at a minimum we should be fully reimbursed for those services.