I hear you. I'm of the opinion whoever is paying the bills should make whatever hiring decision they want to make, for whatever reason they want to make it. Having said that, a smart business person hires whoever best contributes to the bottom line, which is usually the person that can be economically productive with the least supervision and overhead. Personal preferences are one thing, but whether you are a doc in a box, or part of large organization, economics win.
You may have the luxury of being an arm-chair quarterback now, but if you ever hired when your personal economics were on the line, you may sing a different tune. When that happens, your values and priorities change. If you are a slammed FP with little time off, maybe you don't want to dedicate hours each month reviewing the charts of a PA when you can hire an "independent" NP. Maybe you wouldn't be so inclined to hire that PA who is under the BOM when they have little to no experience who has to be constantly baby sat vs. a NP with 10 years of experience. Maybe you wouldn't want to hire a PA whose decisions can come back on your license vs. an NP who has his/her own license and board. Being able to keep your thumb on a PA who is under your own board may not be that great a thing when you are a supervisor of his/her medical decision making and thus potentially held responsible and/or liable for his/her decision making. There is, on average, a lot less of that risk and headache with NP's.
Your retort? Perhaps it's that PA's somehow provide better care having been trained under the "medical model," and you'd go with a PA regardless of economics, time/productivity, and risk. But you have no evidence to show that PA care is better than NP care, and that argument is easily disputed anyway. But it's academic. Why? Because medicine is now 90% run by admin and the government, and they were hired to watch the bottom line. The decision makers don't care in the least about MD vs. DO or NP vs. PA. They. Just. Don't. Care.
