I was going to stay out of this one, but I think we're dancing around the wrong issue here.
We keep referencing what NPs do more poorly than physicians -- we're not acknowledging what they do better. We're thinking of them as WalMart -- undercutting us in cost by way of reduced quality and sheer volume. But that's not entirely accurate -- really, they're more like Amazon. They're undercutting us with not only cost, but more efficient (yes, I know = inferior) training, and slicker business strategies.
This is a problem that starts as early as pre-med. We accept into our medical school students who are good test takers, generally scientifically inclined, a bit more on the bookish and fiscally conservative side. We then train in an environment of hard evidence, neglect to teach them any business or advocacy, and send them out into a changing world that doesn't respect education and experience the same way it did a few decades ago.
The assumption that wealthy people will make intelligent choices is no longer true. Today's elite consumer doesn't necessarily want the pedigree. There's an exploding interest in the spectrum of alternative medicine, from the perhaps useful to the completely woo-woo. The people not vaccinating their children? By and large, they're the people you guys are saying are wealthy enough to pay cash only. The celebrities doing bizarre detoxes and elimination diets? They could afford your hourly rate 10x over.
So this growing body of wealthy people has two options:
1) A well-educated, impeccably trained psychiatrist who says "I trained at XYZ and I'm the best doctor" and provides strong, evidence-based psychopharmacology.
2) A nurse with a glossy website, a good sense of interior design in his/her office, great people skills, and a marketing strategy that offers some version of "I'm a holistic/natural/integrative practitioner who blends natural and modern techniques to harmonize your body with minimal toxicity" etc etc etc
Who are they going to choose?
Main point - you're giving human beings too much credit. Fewer and fewer will care that you're the most competent. More and more will care only if you're selling a message they're buying. Nurses are cashing in on this, and we aren't. Those who say "But we really are providing the best care" -- your words are true.....as they echo and fade into history in the years to come.
We're the Blu-Ray of medicine - it really is better...but who's buying it? Welcome to the future.
Precisely right. But part of the issue is what here - we are bogged down with nonsense. Let's look at this - admission into med school is brutally competitive - realistically most of us wouldn't get into med school these days if we were applying myself included. Some of pre meds have ridiculous CVs - stellar grades, stellar research, volunteer, et etc. For what? Who is truly going to use the physics - perphas the less than 200 ppl per year who go into rad onc?, or biochem, or even chem, etc. All done to dilute and get rid of competition.
The 4-5 years that people spend in pre-med/getting undergrad is useless. This should be done away with.
Then comes the MCAT - pointless test, again does nothing other than exclude people from med school. Then admissions - ok, tons of people don't make it. Then for the lucky ones comes med school. Exceedingly expensive - and we take pointless crap - histology, more biochem, etc. etc. professionalism nonsense, multiculturalism nonsense, etc. 4 years of med school - really? We all know that the 4th year ismostly useless and flufff. some peopl even do research, etc. So 4-5 years.
Then comes residency and the brutality of the match - again countless years of tratining - some needed, some likely superfluous.
Obviously this creates a backlog of yearsssss before a physician is made. So now come the NPs - nurses who may "SEEM" like they know stuff - mostly bc they do the same repetitive thing over and over and over again and typically under the supervision of a doctor, and tend to take care of simpler cases. however bc patietns tend to be more and more ignorant, they have no idea about who treats them!
While NPs with their little nursing degrees and online courses have this brutal, aggressive campaigns since they do what 6 years of training total? while we are taking 24 hour call, 80 hour weeks, worrying about "professionalism" compalints bc we didn't like the call that the idiot nurse made at 2am to asks us about whether the patient can have pudding with their soft diet, cramming for "board exams" that are useless -
again we have no time, and of course we are seen as the "evil" doctors who "golf on wednesdays" while the "poor nurses" do all the work!!
It's gone insane.
I am an advocate for NPs to practice independently - so once the crap hits the fan, and they are sued independently, the cost savings really becomes no cost savings at all. If anything, I have seen countless nightmares from NPs - it increases business quite a bit. Those patients never go back to the NPs.
Inthe famous words of one of my patients, "Doc, my primary care doctor was a nurse!"
Additionally, look at salaries these days - PCPs are making in the high 100's to low 200's - for seeing a crap ton of patients. Why make $180 as a PCP when you can make $110k as a PA when the PCP has more responsibility, more call, tons of debt, etc?
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