Disclosure: I'm a physician.

One popular approach to saving money is to replace physicians with nurse practitioners and physician assistants, who have less education and training. The article does not discuss this element, and I'd be interested to see if that is a factor in patient outcomes. There's less data on this than you might expect.

ETA: From my post lower down, adding for visibility:

[The training gap is] quite a lot more than a year - in primary care, it's more like four additional years of training for physicians, and 15000 supervised clinical hours for physicians (vs 500 to 1500 hours for NPs). The gap can be wider in other physician specialties, because many have longer residencies than the primary care programs. For example, child psychiatry training is four to five years (depending on the route you take), making it longer than the three years of family practice residency.

Here's a chart looking at training for MDs vs NPs in primary care. It is from a physician organization. https://www.tafp.org/media/advocacy/scope-education.pdf

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Jcampuzano2 2 days ago | parent | next [-]

I unfortunately have had to be in and out of medical offices and hospitals recently - and I feel like compared to 10-15 years ago practically everyone I deal with is a physician assistant. Nothing against them but it's kind of annoying that it's almost impossible to actually talk with a doctor anymore.

I get it they're probably overworked too and their time is valuable but it's not quite as reassuring not actually interacting with doctors very much. The few times I have it was literally for my actual surgeries and surgery pre-appointment. Practically everything else is some assistant.

	▲	ivape 2 days ago \| parent [-]
		It’s at the point where we might as well be seen by a CNA who takes blood for the blood test and have the AI assess it (you were too soon my dear Elizabeth Holmes). If we were to just measure the situation, how can we say first-level medical care got better if people are literally no longer seeing doctors?

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tmiku 2 days ago | parent | prev | next [-]

What does that look like in a more intensive hospital setting? I've seen the shift to midlevels happening in primary care, but I'm not sure how that translates to inpatient settings - I'm vaguely aware that there are rules around when a PA/NP must consult an MD before making a decision, and I feel like they would encounter those situations way more for an inpatient.

	▲	phren0logy 2 days ago \| parent [-]
		Many states now have unsupervised, independent practice for PAs and NPs from the first day they are issued a license. There is variation by state, however, and some still require physician oversight. The amount and quality of that oversight also varies considerably.

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SoftTalker 2 days ago | parent | prev | next [-]

The next step is going to be turning over primary care to AI. Doctors will be mostly reviewing cases or consulting when the AI decides it's sufficiently nececessary.

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burnt-resistor 2 days ago | parent | prev | next [-]

Don't worry, MAANG-affiliated startups backed by private equity will work on a way to replace MD/DO/FNP/PAs with AI chatbots so patients can have the full Idiocracy experience while paying zillions for the privilege.

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kjkjadksj 2 days ago | parent | prev | next [-]

I mean we are talking what another year in school? Surely those outcome differences are gone once the nurse or pa is in the field for a couple of years.

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phren0logy 2 days ago | parent [-]

It's quite a lot more than a year - in primary care, it's more like four additional years of training for physicians, and 15000 supervised clinical hours for physicians (vs 500 to 1500 hours for NPs). The gap can be wider in other physician specialties, because many have longer residencies than the primary care programs. For example, child psychiatry training is four to five years (depending on the route you take), making it longer than the three years of family practice residency.

Here's a chart looking at training for MDs vs NPs in primary care. It is from a physician organization. https://www.tafp.org/media/advocacy/scope-education.pdf

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stackskipton 2 days ago | parent | next [-]

I have a family member who is an NP and her biggest complaint is 20 years ago, most NPs were RN who had 5+ years of RN experience then returned to school vs current Undergrad -> NP -> licensed cutting out that practical experience. You think NP would be better if licensing required certain amount of RN clinical time?

	▲	phren0logy 2 days ago \| parent [-]
		I have heard the same concern about undermining trust from some NPs who completed their training before this more expedited route was available.

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kjkjadksj 2 days ago | parent | prev [-]

So then after 10 years on the job there would hardly be a difference in other words.

	▲	phren0logy 2 days ago \| parent [-]
		I would argue that supervised training with regular feedback on performance is different than job experience, but certainly both are relevant.

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paxys 2 days ago | parent | prev [-]

Or how about - train more physicians. It is one of the most critical and in-demand professions yet the most artificially gatekept. Doctors will endlessly compain about working conditions and patient load but still not agree to this because they know it will devalue their own labor.

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phren0logy 2 days ago | parent [-]

Major medical organizations have been advocating for years for more physician residency spots. Unlike NPs or PAs, some residency is required for physicians to be licensed.

Right now, there are not enough residency spots for every US med school graduate.

	▲	paxys 2 days ago \| parent [-]
		The AMA very successfuly lobbied to reduce the number of medical schools, cap federal funding for residency and cut the number of residency slots 20-30 years ago, and we are now dealing with the fallout of that. It has softened its stance in recent years, sure, but even if we fix all of this today (doubtful because of the usual political gridlock) it will be another couple of decades before the situation will actually improve.