The Decline of Physicians: Do we really need them anymore in Primary Care?

Specialties NP

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Legislature Votes to Make NP Payment Parity Law Permanent - Nurse Practitioners of Oregon

Oregon equal pay for equal work law has been signed into law in an independent practice state with NP's and PA's getting paid FULL amount from private insurance. This means that a new grad NP's will be paid the same amount as an attending family physician and psychiatrist and also have the same rights and scope of practice as a family physician and psychiatrist.

With the tremendous push for equal pay and for autonomy for PA and NP, is there any reason for medical students to want to go into primary care anymore? I guess my question is, it seems so bizarre that someone would put themselves through hell when they could become a competent provider through the NP route or PA route.

So do you think with these new laws, PA's and NP's will ultimately lead primary care? will these laws drive away medical students from primary care? Is it financially reasonable for a medical student to become a family physician in an equal pay state?

As an sNP, I'm incredibly thrilled and happy at how much progress our profession has made. However, I also understand how some medical students hoping to go into family medicine can feel cheated and grumpy about it. What are ya'll thoughts?

On the job training like everyhting is the most important. Lengt of education doesnt matter. Studies shown np are supeiror if not equal providers compared to md. Np education is more efficient than md education which wastes a tremendous amount of time and money.

Family doctors are more critically needed than ever. NPs are not the equivalent to an MD no matter how much some think they may be.

Specializes in Psychiatry, Community, Nurse Manager, hospice.

I think NPs will eventually replace physicians in primary care and probably in outpatient psychiatric care too. Not so for PAs, they require a physician to work under. I think the nursing model works better for primary care, and this is not physician bashing on my part. Physicians have a very important role to play, but I think their services are better utilized in acute care and in specialties.

So you'll see your NP for your routine stuff, your minor illnesses and to manage the common chronic illnesses. When your NP sees something that s/he can't handle, then you'll be referred to a specialist who will be a physician, or at least work with a physician.

I think this is the best way to give everyone the best care and use resources most efficiently, my opinion is not about bashing physicians or inflating NPs.

I see people complaining about the amount of NPs being created, however it is good that nursing is addressing the problem of healthcare provider shortage. Medical schools are not addressing this at all, and this is because it is really not their domain/strength. Medical school is about finding the source of disease, not about addressing the other factors that contribute to the overall health/wellness of the patient/public. Nursing is stepping up, because this is a nursing issue.

Nurse practitioners are nurses. They are not junior physicians or physician extenders. PAs are physician extenders and will continue to have that role and there is absolutely nothing wrong with that role.

Specializes in Pediatric Critical Care.

I think there will still be some physicians that want to go into primary care. I mean, its not a top paying specialty now, so if money was the only motivation....no one would choose it now. Yet some still do, because some people WANT to work in primary care. I don't think that will entirely change.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

OP, as "troll-ey" as your thread seems to come off, I think your questions could lead to some really serious and intelligent discussions. It's not the first time I've heard this issue and I'm sure these questions didn't just pop out of nowhere in your case. I've even heard comments from specialist physicians I've worked with who have said the very same thing: "why do we need family physicians?". I think because they are specialty physicians, they may not really understand the breadth and scope of family practice especially when you get deep into their work in rural communities. They also are not threatened by "NP encroachment" and job security because we ACNP's are "comfortable" in a collaborative climate in the acute care setting.

To answer you questions, I think we have to look at the realities nurse practitioners in general face. Oregon may have passed a law regarding pay equity for all types of providers (and BTW from what I know about it, the law won't take effect unit a couple of years) and we may have many independent practice states now but overall, there are still many practice barriers for NP's. Are these practice barriers preventing those that went into FNP or AGPCNP to venture into purely primary care practices? What's the actual percentage of NP's who trained in primary care that actually go deep into rural communities and work there as primary care providers?

I also think (and I can be wrong) that urban and suburban primary care provider pools are still dominated by physicians. I see family practice and out-patient adult medicine openings everywhere in my metro area seeking physicians to a larger extent and not NP's. Part of that is the "corporate-ization" of Medicine where larger health systems (such as Kaiser here in California) have become employers of physicians including those in primary care. Much of the FNP market in urban areas that I see are Minute Clinic type settings where the kind of work is something that physicians wouldn't necessarily go for. I actually blame this current climate for why many FNP's go into specialty practice

Boston how do you think the outcome data will fare 5, 10 years down the road with the current trend of schools retaining undergraduate students through NP without ever having worked as a RN?

I thought I was having an actual break with reality when I first heard this because it's beyond my current understanding of how reality should work. I have never heard of anything more insane and short sighed in my life!

Specializes in ICU + Infection Prevention.

Equal pay for equal work should it be independent of qualifications?

If you hire a master carpenter, you might pay more than an apprentice carpenter.

BSNs want extra pay for their degree. People want extra pay for certifications. Do DNPs want extra money over MSNs?

OK what about MD vs NP/PA pay again?

Market forces vs legislation fixing pay? Is that a good idea?

This issue is complex...

Specializes in Family Nurse Practitioner.

I see people complaining about the amount of NPs being created, however it is good that nursing is addressing the problem of healthcare provider shortage. .

Speaking only for myself I'm not complaining about the number of NPs being created what I am complaining about is the lack of RN background, lack of criteria for appropriate applicants and superficial education that I, as someone who went through 2 well respected brick and mortar NP programs, believe NP programs are lacking. It disgusts me to hear this justified due to a lack of providers and time frames they are trying to fill to meet these needs. This is especially disturbing to me in my specialty, psychiatry, where we are treating particularly vulnerable patients who need and deserve quality prescribers who actually know what they are doing.

Specializes in Adult Internal Medicine.
Boston how do you think the outcome data will fare 5, 10 years down the road with the current trend of schools retaining undergraduate students through NP without ever having worked as a RN?

I have no idea what outcome studies will look like then, we can all venture opinions, but it remains just anecdotal. As I have said several times, that we need to root out subpar programs.

As far as prior RN experience, I don't really think that is a major issue. A quality program with quality candidates will produce a quality NP regardless of prior RN experience.

Specializes in Adult Internal Medicine.
It disgusts me to hear this justified due to a lack of providers and time frames they are trying to fill to meet these needs.

I absolutely agree this is a problem. Quality over quantity. Programs churning out subpar novice NPs hurts us all in many ways and hurts patients.

Specializes in Adult Internal Medicine.
Family doctors are more critically needed than ever. NPs are not the equivalent to an MD no matter how much some think they may be.

Equivalent in what way? What's the most important way to judge providers?

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