NBER white paper comparing ER physician and NP productivity

[CyberMaxx]

This white paper was recently posted in a non-SDN radiology forum which I thought may be of some interest here. It is recently released paper from an economic think tank (National Bureau of Economic Research) which compared MD and NP productivity in the VA. Some nuggets from the abstract include:

"... we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes."

"Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’."

The Productivity of Professions: Evidence from the Emergency Department

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

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[Jabbed]

“Using data from the Veterans Health Administration…”

 

[CoolDoc1729]

This white paper was recently posted in a non-SDN radiology forum which I thought may be of some interest here. It is recently released paper from an economic think tank (National Bureau of Economic Research) which compared MD and NP productivity in the VA. Some nuggets from the abstract include:

"... we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes."

"Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’."

The Productivity of Professions: Evidence from the Emergency Department

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

Well in the VA a cost is a cost .. they all go in the same ledger .. they pay the facility fee and the lab cost and the rads cost and the physician billing whereas with everyone else the goals aren’t aligned that way .. the insurance company wants us to order less tests but the hospital profits if we order more.. so I’m not surprised that this came out of the VA rather than like .. ascension

 

[RustedFox]

In related news, water is wet.

How many times a shift does a PLP come to you with a case and you wonder "why they got a (CMP/CBC)" and you ask them, only to have them respond with a shrug and something like: "Well... I had to do something" - ?

 

[CoolDoc1729]

In related news, water is wet.

How many times a shift does a PLP come to you with a case and you wonder "why they got a (CMP/CBC)" and you ask them, only to have them respond with a shrug and something like: "Well... I had to do something" - ?

Had to do something
Did not want to drain the boil
So I ordered labs

 

[WilcoWorld]

This white paper was recently posted in a non-SDN radiology forum which I thought may be of some interest here. It is recently released paper from an economic think tank (National Bureau of Economic Research) which compared MD and NP productivity in the VA. Some nuggets from the abstract include:

"... we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes."

"Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’."

The Productivity of Professions: Evidence from the Emergency Department

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

Thanks for posting this. Even seemingly obvious things (perhaps ESPECIALLY the obvious) should be assessed scientifically.

We just need to have US Healthcare decisions actually be motivated by cost containment and better outcomes in order for this data to have an impact. The VA is one of the few venues in the US where this is the case.

 

[GassYous]

Just think it's funny that they are measuring productivity at the VA

 

[GonnaBeADoc2222]

In related news, water is wet.

How many times a shift does a PLP come to you with a case and you wonder "why they got a (CMP/CBC)" and you ask them, only to have them respond with a shrug and something like: "Well... I had to do something" - ?

Yes, but it helps to have actual numbers to back up what we know to be common sense to combat the AANP funded and conducted pseudoscience.

 

[Apollyon]

Had to do something
Did not want to drain the boil
So I ordered labs

Your second line has 8 syllables!

 

[RustedFox]

Your second line has 8 syllables!

Did
Not
Want
To
Drain
The
Boil.

That's 7, amigo.

 

[Apollyon]

Did
Not
Want
To
Drain
The
Boil.

That's 7, amigo.

Boil is two syllables.

Believe it or don't, this is a legit grammar discussion point, among linguists and grammarians.

 

[xaelia]

Boil is two syllables.

Believe it or don't, this is a legit grammar discussion point, among linguists and grammarians.

This thread has gone to a dark place, recommend temporary account suspension.

 

[bravotwozero]

We’ve got people coming up with insults in Haiku format.

Lol.

I love this forum.

 

[turkeyjerky]

We’ve got people coming up with insults in Haiku format.

Lol.

I love this forum.

Depression and cynicism are great for humor!

 

[turkeyjerky]

Here's some midlevel logic that I seem to see all the time: they'll order unnecessary labs or scans 'because the patient's been waiting so long, I felt bad for them'. Leaving aside the fact that they're extending that specific patient's total length of stay unnecessarily, as well as the fact that meaningless labs or imaging, literally, mean nothing (not to mention the misplaced guilt over someone who chose to come to the ER and wait hours for what is inevitably a plainly obvious nonemergent complaint), they never seem to realize that they are compounding the problem!

 

[AlmostAnMD]

We need to circle back to boil being one syllable. It it an accent thing? How could anyone think thats one syllable?

 

[VA Hopeful Dr]

We need to circle back to boil being one syllable. It it an accent thing? How could anyone think thats one syllable?

Southern accent

 

[Apollyon]

We need to circle back to boil being one syllable. It it an accent thing? How could anyone think thats one syllable?

In conjunction, I recall a "roiling boil" (a very vigorous boil, as for Mexican hot chocolate, to which was alluded in Laura Esquivel's Like Water For Chocolate, which, at the time, was the best movie I'd ever seen, although I didn't read the book). "Roiling boil", to my ear, has 5 syllables.

 

[CoolDoc1729]

We need to circle back to boil being one syllable. It it an accent thing? How could anyone think thats one syllable?

Wow, I had no idea my post shift poetry could start such controversy.
First I had “thing”
Then I thought it might not convey the laziness of pretending an abscess needed something besides i&d, but that’s like gross eww
But abscess is unequivocally 2 syllables
So I settled on boil. Idk I feel like it has more than 1 syllable but less than 2 somehow?

 

[RustedFox]

1 syllable.
You don't say "BOY-YULE" like you were a white guy mouthing off lyrics in a Jay-Z song.

I got 99 problems, but this ain't one.

Rap patrol with the boil patrol.
Foes that wanna make sure my casket's closed.
Forum critics that say he's money-cash-hoes.

 

[DeadCactus]

No matter how minimal the emphasis on the "l" in boil is, no one is pronouncing boil as "boy" and there is no way to make any variation of an "l" sound without introducing a vowel sound and thus a new syllable.

 

[EMhawkeye]

The only way I can think of to make boil into two syllables even in the south is by calling it a risin ie the other name for it I encountered in ol' dixie.
I almost DFO'd the day I saw "rising on my pie" listed as a chief complaint.

 

[Mount Asclepius]

I love this thread. Reminds of all the debates I have in the doc box on shift. Nothing to do with medicine. All to do with interesting.

 

[dchristismi]

Bo-il, is it one
Or two? Depends on how far
in the South the drawl.

And I would expect
No less than haiku as the
Preferred method here.

 

[CoolDoc1729]

I love this thread. Reminds of all the debates I have in the doc box on shift. Nothing to do with medicine. All to do with interesting.

I’m sitting here reading with my first grader dying laughing because he’s saying sell-boat instead of say-yul-boat and it’s the same thing isn’t it 🤣

 

[Janders]

We need to circle back to boil being one syllable. It it an accent thing? How could anyone think thats one syllable?

Thought the contrary
Who splits boil into two beats
BOUHL not Boy-Yal, ya’ll!

 

[southerndoc]

Lestin' har, if we say boel and y'all says boe-el, wells its all da same up in cheer. Up yunder, dem yanks say it weird. C'mon down har and let us shows yew sum good ole Suthern hospitality. I'm fixin' to drane a risin as we speak.

 

[RustedFox]

Bo-il, is it one
Or two? Depends on how far
in the South the drawl.

And I would expect
No less than haiku as the
Preferred method here.

As I suspected
A haiku would bring you back
Nice to hear from you

 

[EctopicFetus]

This research shows what we all know. LLPs dont know a lot, their workups make no sense and the more independent the dumber the workups and the more patients suffer.

 

[RustedFox]

Nocturnist perk at CurrentJob: only have a PLP for 1-2 hours. Don't have to babysit much.

 

[Fox800]

Here's some midlevel logic that I seem to see all the time: they'll order unnecessary labs or scans 'because the patient's been waiting so long, I felt bad for them'. Leaving aside the fact that they're extending that specific patient's total length of stay unnecessarily, as well as the fact that meaningless labs or imaging, literally, mean nothing (not to mention the misplaced guilt over someone who chose to come to the ER and wait hours for what is inevitably a plainly obvious nonemergent complaint), they never seem to realize that they are compounding the problem!

Rename the ER to "Tests 'n Pills™" and you just answered your own question.

 

[RustedFox]

Rename the ER to "Tests 'n Pills™" and you just answered your own question.

He-hey-heyy... That's thegenius' idea.

 

[thegenius]

He-hey-heyy... That's thegenius' idea.

Going nationwide, 1000 locations coming soon.

 

[MechEDoc]

In related news, water is wet.

How many times a shift does a PLP come to you with a case and you wonder "why they got a (CMP/CBC)" and you ask them, only to have them respond with a shrug and something like: "Well... I had to do something" - ?

Just had the question: "did you get a blood gas?" Umm, no, why? They're hypoxic from CHF, we already have enough data...