MedicalResearch.com Interview with:
John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.
We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.
MedicalResearch.com: What should readers take away from your report?
Response: In a large nationally representative sample, nurse practitioners, physician assistants, and physicians provided similar amounts of low value care—dispelling physicians’ beliefs that nurse practitioners and physician assistants provide lower value care than they do. Our study suggests that as the primary care physician workforce continues to shrink, expansion of nurse practitioners’ and physician assistants’ scope of practice does not appear to undermine efforts to maintain high-value care.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: More research needs to evaluate how nurse practitioners and physician assistants can best provide primary care in a team based setting. Particularly what types of patients/cases should be triaged to nurse practitioners (NPs) and physicians assistants (PAs) and what types go to physicians? How should NPs or PAs manage more complex or emergency cases? Currently, we triage those cases to physicians and we still are trying to understand NPs’ and PAs’ role among sicker and more complex patients.
No disclosures or conflicts of interest.
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John N. Mafi, MD, MPH; Christina C. Wee, MD, MPH; Roger B. Davis, ScD; Bruce E. Landon, MD, MBA, MSc
Annals of Internal Medicine 16 AUGUST 2016
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