Agree to not minimize the challenge of quality primary/generalist care. I'd just say, not all are inadequately trained, that it is possible to learn on the job and train with time, that the counterfactual in many areas is not quality physician care but often no care, etc. We are in sync on the challenge but perhaps not on the solution.
I think one of the issues is that there is literally no quality control, and the governing organizations, specifically the AANP, is diametrically opposed to methods of competency or formal qualification.
To give you an idea, they abandoned attempts at a higher level of standardized examination (i.e. the simplified and abridged Step 3 developed by the NBME that only about 30-50% of the highest trained NPs could pass), they actively oppose requirements for "residencies" or advanced training for FPA, they actively oppose more stringent standardization of NP training - leaving room for literally hundreds of online NP schools partly why graduates have quadrupled in the last decade, and as pointed out in their lunch talks and lectures many high-level NPs in the AANP essentially believe that the argument for FPA is completely unrelated to standardization of training. With that kind of representation and lobbying, do you truly not see the issue?
On top of that, state nursing boards are simply incapable of effectively taking action against dangerous NPs due likely to underfunding and the sheer amount of nurses they govern over. This is typically rarely an issue, because most nurses have oversight, but in the case of FPA, many NPs will not.
When training standardization and oversight is not possible and opposed, supervision becomes even more important.
There absolutely are excellent NPs and PAs, and crappy physicians. Physicians aren't saying midlevels shouldn't exist, they are saying there should be supervision.
www.aaemrsa.org
