I think physician assistants and nurse practitioners (known collectively as physician extenders) should have a limited role in our health care system. As a general rule they do not have the quality or quantity of training necessary to function as a doctor though they often do.
Nurse practitioners are registered nurses whose post high school education can be as little as two years for an associate degree in nursing (or up to 5 years for a bachelor of science degree in nursing), and who then undergo as little as under 18 months training, which can be completed online. In Indiana they are required to practice medicine with the "collaboration" of a physician. This does not require the physician to directly supervise or even to be in the same building or city as the nurse practitioner. They are permitted to prescribe all medications that a physician can with the exception of prescriptions for weight management.
Physician assistants are non-physicians who depending on the particular educational program, are high school graduates who may or may not have previous health care experience and/or some college education. The two training programs in Indiana require up to 2 years of prerequisite college work followed by 2-3 years of specific classroom and clinical training.An internship or residency is not required. They are required to be supervised by a physician but the supervision is not necessarily in person. A chart review within 24 hours of the visit is required. They are not allowed to prescribe medicine in Indiana.
A physician's training requires a minimum of successful college undergraduate college degree followed by medical school, usually of 4 years duration. A one year internship in an accredited training program is usually followed by between 2 and 9 more years of education depending on the particular specialty.
The reason for physician extenders depends upon whom you ask. Those that are physician extenders like the work that they do and the money they make for the amount of time and training they put in. The doctors who hire them, like charging patients and making money without having to see any extra people. Patients may like them so that they can get seen sooner than they otherwise could as the doctor's office now has more appointment times available.
I think there are several problems with the whole concept as it currently exists.
First of all, they are not needed. If there were not enough commercial airline pilots, would the solution be to allow a less rigorous and shorter training period and allow those people to have their flight logs inspected within 24 hours of a flight. (That's a rhetorical question by the way.) If we don't have enough doctors we need to have more medical schools. If we don't have enough applicants, we need to make the job more appealing (lawyers, the government , and insurance companies will be addressed in other articles on ways they make the job often unappealing).
Secondly, they do not have the depth of training that a physician has. They may be able to see and treat many conditions, but they may not pick up a serious and/or unusual condition, as many present similar to innocuous ones. If you haven't at least heard about and studied a disease you are not going to be able to diagnose it. They may be good-hearted, hard-working people, but they are not doctors. More often than not, they independently evaluate and treat patients with the physician only briefly reviewing the chart or discussing the case without ever personally examining or talking with the patient.
Thirdly, as a patient, I wouldn't like being charged the same amount for seeing the physician extender as I am when I see the doctor. When you go to law firm, accounting firm, or most other businesses, you get charged more by the people in the organization who are the most knowledgeable and have the most experience. This is widely accepted and makes sense. If I don't need a higher level of expertise I don't want to pay for it. In the doctor's office however, you pay just as much whether you are seeing the doctor or the lesser trained physician extender.
I think the appropriate role of the physician extender is to assist a doctor with various patient tasks or procedures. They should not independently be the first to evaluate and treat a patient. They could also follow along a patient with a chronic condition with a physician to oversee the plan once the physician has initiated a treatment plan.
At an office visit you are paying for an evaluation and treatment by a physician. I guarantee you that if your doctor needed to have a medical problem evaluated; he would not accept being evaluated by a physician extender. I know I wouldn't. You shouldn't either.
