Ok it took me a while but I found something
The first line of the discussion in the paper titled "
Practice characteristics of primary care nurse practitioners and physicians." from Nursing Outlook (obvious bias noted) in March of 2015 is that, "PCNPs are more likely than PCMDs to practice in urban and rural areas".
What they don't tell you is that the difference is only 4%...
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The column identifiers are NPs on the left then MDs on the right, this was on the bottom of a table.
Does this "MDs" category include DOs. I suspect that it doesn't. There are plenty of DOs that go into rural medicine. It might only affect it by a couple percentage points (considering DOs only represent like 10% of US docs), but it might be enough to skew the results.
just wondering, why do you think these NP make great clinicians? Was is because of the particular school/training program they went through?
I've seen some NPs (and PAs) that were great and some that were terrible. The difference is likely a combination of their schools, their training (some NP/PA residencies) and their personalities.
I talked with a PA about their curriculum, and this was at a very highly rated/competitive PA school in my hometown. At the time I was starting 4th year. They told me about how they were in the "A-track". Apparently their class was split between an A-track and a B-track, and the A-track people get access to the better rotations (obviously their choice if they wanted them or not - the A-track people could choose B-track rotations) and B-track went to the worse/lighter rotations (mostly out-patient, carrying no more than 2 patients at a time, significantly less actual hrs, a max of 8 hr shifts, etc). It was kind of depressing. In the end they all graduate with the same degree from the same program.
The university I'm at for residency has one of the top PA programs in the country (or so I'm told). There are 1-yr PA residencies, and we honestly have some amazing PAs, but its a subset and they stick in their roles tightly - i.e. same specialty and are under the attendings.
To give you an idea, on one of my first intern year rotations a PA was being added (they'd apparently been there for weeks before I came on). Our work was ultimately identical and training was similar (they'd done a 2.5-3 yr program that mimicked the MD curriculum minus shelfs and boards + a 1 yr residency in the field they were practicing), but they couldn't carry more than 2 patients at a time, and even had to ramp up to that over the 1-2 wks I was there. The interns were expected to carry 7 on day 1.
At that point it made me wonder if part of what makes our training more intensive is the responsibility of it. We're expected to be responsible. We're expected to handle situations we're not all that familiar with. We're expected to jump right in from day 1, because we only have so much time to learn it.
As for NPs, there is a TON of variability in quality. Some programs try to do what PA programs do (i.e. mimic at least some aspects of the MD/DO curriculum), while others are like 50-75% online and little more than an advanced degree in nursing theory.
One thing I've also noticed anecdotally as a stark difference with the NPs is that they are more likely than not to do more tests, get more consults, and ultimately go along with what the patient or family wants even if its counterproductive. We've all been guilty of those too, and I'm sure I will continue to be guilty of it from time to time, but there are some situations where its clearly a waste or just the wrong decision.
I don't know, there's probably a personality component, but it seems to be the best ones that stay with the hierarchy. Its funny, because the people I'd trust most on their own, would rather not be (i.e. they know what they don't know).
Fine with me...ideally eventually people would realize the knowledge difference and either they would have to do more schooling or be knocked down a peg. Might be the only way to break the propaganda. Also, I feel like as a malpractice insurance agency I'd be charging $$$ for their premiums due to the lack of comparable schooling. Like another poster said...put up or shut up
Yeah, except most people are terrible with recognizing quality of the care they're given. If they like the person, it almost doesn't matter how bad they are, and in my (admittedly limited) experience, NPs tend to tell patients what they want to hear.
...4) Specialists exist for a reason. There has been some literature suggesting that NPs refer more than MDs do. I'm unsure exactly how this will impact things over time, probably a combination of both good and worthless referrals coming to specialists' offices. That said, it provides another route by which an NP can get a patient evaluated when they have reached the limit of their own knowledge and experience....
I think one of the big detriments is going to be healthcare costs. Healthcare is already expensive, and one of the biggest values of primary care is the cost saving factor of providing better, cheaper care with prevention. Having NPs take over the PCP roles would probably at very least decrease this cost saving aspect of primary care.
I'd also argue that good primary care is pretty hard, especially when it comes to the times when you shouldn't just follow an algorithm. I believe NPs certainly have a role, but I still think that role is under a physician that can step in when they need to, which by definition should only be a fraction of the time.
...6) The rise of online specialty consult services and machine learning products. Online specialty consult services like Rubicon are already offering subscription-based e-consults for PCPs. Machine learning based products are surely on the horizon offering natural language recognition and able to integrate all the available clinical data and suggest diagnoses and guide treatment plans.
Completely unrelated, but on the horizon maybe. The AI and machine learning still has quite a long way to go before replacing docs. Doubt I'll see it in my career, but maybe in 40-50 yrs. Gotta change the culture too though, before care is given exclusively by machines.
A much more pressing concern is a future where basically an RN puts in a subset of predetermined data into an algorithm (as opposed to a purely dynamic system that you just talk to). They're already doing it in some desperate or resource limited areas with a modest amount of machine learning.
Yet there are unfilled spots in primary care and other high-need specialties every year, are there not?
ETA: And plenty of those spots going to IMGs/FMGs, not to say that's inherently bad and/or they don't play an important role in the healthcare system, but it still reflects a low desire by AMGs to go where we're most needed.
There are unfilled PC spots prior to the SOAP, but the numbers have gone down significantly even with the match. There were 141 FM spots, 132 IM spots, and 45 Peds spots unfilled in the 2017 match. By the end of the SOAP only 14 of those combined weren't filled (some - 5 - actually may have been filled, but they weren't in the SOAP).
Sure IMGs/FMGs make up a chunk, but with the expansion of US MD and DO schools, more AMGs are actually going into primary every year (sure out of necessity, but still).
I also don't know that it matters that IMGs/FMGs are going into those spots. Its still PC training spots being filled. Its not like we've got a rash of unfilled PC spots hanging around. They're almost completely filled every year even when there's an expansion in PC training spots, like we saw over the last 5-10 yrs. Residency spots is still the limiting factor for our ability to produce primary care physicians (or any physicians for that matter).
