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    Perils of replacing physicians with non-physician providers

    Part 1

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Rebekah Bernard, MD, a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    The United States is facing a .[i]  Efforts are being made to increase physician training programs through Graduate Medical Education (GME) funding, with bills H.R. 2267 and S. 1301 slowly winding their way through the political process. In the meantime, some organizations see the physician shortage as a golden opportunity to increase the production of non-physician healthcare providers, including nurse practitioners (NP) and Physician Assistants (PA). Dr. Bernard

    Nurse practitioner organizations have been particularly active in promoting a nursing role in the health system, encouraged by the Institute of Medicine’s 2011 report, which called for a radical change to health care delivery in the United States with a push towards higher levels of nurse education to achieve “full” nurse partnership with physicians.[ii] Nursing schools rallied to the call of increasing baccalaureate trained nurses and doubling the number of nurses with a doctorate degree by 2020.[iii]


    RELATED: How can physicians combat industry shortages and meet patient demands?


    Unfortunately, this focus on increasing nursing scope of practice has led to several dangerous consequences. The first adverse effect of increased NP production is a decline in bedside nurses, one of the most critical components of our healthcare system.   

    Bedside nurses are the cornerstone of quality medical care delivery across healthcare settings.  The United States is facing a nursing shortage, due to a combination of factors: the aging of the population, retirement of experienced nurses and the transition of nurses from bedside to a provider role.

    The first way that increasing nurse scope of practice is affecting bedside nursing is that as nursing programs encourage more advanced training, fewer students are entering .[iv]  Associate level (ADN) registered nursing degrees are two-year programs, available through community colleges, which offer a shorter and less expensive track toward becoming a nurse.  Students can work and attend school at the same time, and can enter the workforce after two years of study, rather than four.  

    Next:" Simply substituting one for another isn’t the answer"

    Rebekah Bernard MD
    Dr Bernard was a National Health Care Scholar and served at a Federally Qualified Health Center in Immokalee, Florida for six years ...

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    • UBM User
      If the issue of nurses being better prepared with Associates degrees then BSN's is a lesson then why are we so absolutely stubborn and refuse to follow the same process? The medical community has held onto our nonsensical university roots for WAY too long. Requiring 12 to 16 years to pop out the back end as "fully qualified" is our own demise. We get everything we deserve from a capitalistic community desperate to provide care and earn a living. I give credit to the NP and PA sections. They realized that the MD community was NEVER going to stop the nonsensical requirements and extra time spent in school simply to feed the university coffers for their $25K++ per year tuition obsession. Want to solve the physician shortage? Simple, cut out the BS requirement and then get the students into actual patient care in year one rather than cadaver lab and biochemistry. I have trained more morons in surgery then I can imagine and amazingly the common denominator of the good ones is those that realized quickly that this was a game to play did the best. They might not have gotten the best grades but they ended up the best providers. We need to stop placing university protocols on the pinnacle of our leadership mountains and instead use universities for what they are and that is only training facilities Nurses, engineers, musicians, see their university requirements as the stepping stones to getting into the bigger game while medicine sees the university and it endless requirements (even including future CME) as the brass ring and all others need to bow to them forever We can EASILY fill the void by cutting down the requirements and adding in MORE clinical time that enriches the students so they obsess about patient care and not about passing tests and or meeting educational objectives Dr. Dave (H&N surgical oncology)

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