Hey, you know about those "fluff" courses we take in nursing school and NP school that you claim we have too much of in our curriculum? Well a few of those research and theory courses we take focus on just that: RESEARCH. The course I took in graduate school called "Research" was a graduate level course that focused on things involving grading research, creating research plans, and disseminating evidence based findings into practice (among several other things). That is what my courses in nursing theory and health promotion and disease prevention also taught..
You don't think I see the limitations of these studies? Do you know how difficult it is to measure and control all the components you are asking for in a study like this? You care so much about this, how about you publish a study? Nevertheless, I agree, the studies have their limitations (e.g., short follow up periods and lack of controls). Although outdated, there were well-publicized, well-conducted randomized trials conducted in the 1970s that proved the concept that an autonomous primary care APRN can deliver care comparable to that provided by a primary physician (Burlington Randomized Trial of the Nurse Practitioner, the St. John's Randomized Trial of the Family Practice Nurse). These studies may have made further proof of equivalence seem unnecessary, particularly since independent APRN practice in primary care and urgent care were widely implemented in many states and throughout the VA, where rigorous quality assessment has been applied since the 1990s. But with increasing complexities in primary care, definitely its clear that more studies that measure more variables need to be done with further quality assessment measures in areas like the VA where independent practice is present and data like this can be tracked (VA still does this). With that said, to date, all the studies I've come across are reassuring and have not shown any significant differences in the measures like practice patterns, frequency of tests ordered, quality of life, mortality, etc. Of note, there is a policy paper Newhouse and colleague and studies by Naylor and Kurtzman that I suggest you look at since you're all about good evidence. The data from the former and the later papers were major and corroborate what I've been arguing regarding independent ARNP practice. In fact, these were the studies that the Institute of Medicine and RWJF used to back up their calls for NPs to practice at the top of their licenses and their claims that there is no practice differences between the two groups.
Now read carefully "Foxy". Having said everything I just said, I'm still for the team based approach in a majority of the areas of medicine. Obviously, an NP will not practice independently in specialty areas. Of note, no NP I have ever met is against working with or for physicians. I (and most nurses) have a ton of respect for doctors and know our place in matters of complicated medical issues that are outside our scope..Need I repeat that? Because this is the 2nd or 3rd time I said this to you. In areas where there is decreased access to primary care services or same day visits; or where physician collaboration is highly inconvenient or impossible; or in general where access to health care services may be limited; my stance (and the stance of many others [i.e., physicians, nurses, administrators, the public, and policy makers]) is, and will be - until data says otherwise - that NPs should absolutely be allowed to practice autonomously. We know our scope and when to refer. I'm so convinced of this that 21 other states (and counting) and D.C. are making this a reality.
You mentioned that I "claimed equivalence, which goes against all the good evidence out there." Do you have data that negates any points I have made so far? Care to site anything?
All the best Dr. "Foxy".
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians
Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses - VA Evidence-based Synthesis Program Evidence Briefs - NCBI Bookshelf