Would it be possible to demonstrate, from a thorough analysis of chart documentation – especially of Decision Making – that internists show, from the gitgo of their professional relationships, “complex comprehensive care” while PA’s and RNP’s show simpler Decision-Making? Are there index cases where this complexity saved lives while reducing the cost of care? Would a blinded group of quality medical judges (doctors, insurers, policy wonks, patient advocates, etc.) be able to pick out from a large enough group of charts those patients who had received only doctor-care vs those who had received only RNP care vs those who had received a mixture? And then could you map the cost of care for basic pathology in each group (e.g., CV, pulmonary, ortho, etc.) against each cohort and follow changes in morbidity and mortality as well?

Is this too ridiculous to do? I’m guessing that this is the kind of data that Pete Stark at the House Ways & Means Subcommittee on Health would like to see.

I don’t at all disagree with you, Sharon. But this may just end up being a tug of war and the decisive factor may be cost of care – unless we can show “medical necessity” for the presence of the physician. It seems to me that here is a chance for medical academe to demonstrate more than moral support.

An interesting topic and comments that follow. It is obvious that even many “medical people” do not understang the role of the nurse practitioner since their comments are minimalizing and denigrating – Jiffy Lube? Fine – keep on thinking that NPs are “simple” and can’t handle “complex” patients. We want to work together with you so that we can care for the many patients that don’t have providers. It’s ok for NPs to care for the un or underinsured but don’t let them care for the patients with real insurance. There is no evidence that NPs order any more tests or referrals than any other provider.

We as NPs will continue going into primary care when many physicians completely avoid it and are leaving in droves. We want to partner with you – not so that you can supervise us – but so that we can collaborate and bring best practices to our patients. Is it not possible that NPs have areas of specialty where we are better equipped to handle a certain situation or patient? Perhaps you all have worked with what you consider substandard NPs – has that not happened with your physician colleagues?

The argument becomes so tired. Our healthcare system is literally falling apart and costing trillions while many people go without care althogether. I challenge us all to find a way to work together and form a model of care where the best clinician is taking care for that patient at the right time and place.