Responding to my argument yesterday that we could ease the primary care crisis by radically expanding the number of nurse practitioners, Kevin MD says sorry, but "there are not enough of them." That might change though, if the profession gave them more respect and responsibility, rather than forcing them to attach to a doctor or work in a MinuteClinic. What wouldn't change is Kevin's other point, that they, too, are being drawn into the specialties. Duncan Cross, however, disagrees with Kevin, and takes it a step further. Don't think of them as a stopgap for the primary care shortage, he argues. Think of them as the basis of a renewed primary care system.
The median physician in family practice makes $137,119 -$156,010; compare that to surgeons at $228,839 and up.By contrast, the median physicians' assistant makes $69,517-80,960 - and can do just about everything a PCP might do.So if we're going to spend more money on primary care, it's a lot more efficient to do so making PAs a priority, rather than physicians. Obviously, 20% of 70 thousand is a lot less than 20% of $140,000 - and we can hire two new PAs for what we might have spent on one new PCP.But what's also clear from these numbers is the gap in physicians' salaries - about $90,000. If the real problem is the differential between primary and specialist pay scales, then a 20% increase in general practice salaries only narrows the gap to about $60,000 dollars - still a pretty big differential. If narrowing that gap is the key to fixing primary care, then it's going to be tremendously, maybe prohibitively expensive.Whatever the gap between specialist and generalist PAs (the BLS isn't very specific here), it simply can't be as big a problem as it is for physicians. Thus PA's salaries will be far more responsive to modest absolute increases: a $28,000 raise is going to mean a lot more to a PA than it is to a PCP. So again, the problem is much easier to solve if we look to PAs (and nurses) as the key to primary care.
What Kevin's saying makes sense in the short-term: We can't produce enough Nurse Practitioners to solve the primary care problem if current trends continue. But in the long-run, Duncan's point makes sense. And anecdotally, I've had similar experiences to Megan: My interactions with nurse practitioners have been far better than my interactions with doctors, and they've often centered around fairly complex problems. Medical schools selects for science skills. Nurse practitioners tend to be far better at dealing with patients. At the primary care level, that might actually mean, in a fair number of cases, that they're actually preferable.
