Physician Shortage: The Current Public Health Crisis

It seems that we only value public health when there is a crisis, otherwise public health and prevention are often forgotten and take a backseat to the current issues in health care. This is why it is so important to know your history, the history of the advancement of medical training and healthcare delivery. Without knowing history (in all areas, not just in medicine), we tend to go backwards and repeat the same mistakes.

We are currently in a public health crisis. Allowing NPs and PAs to practice medicine without the proper medical training will leave an imbalance of quality medical care for everyone in the US. We are going backwards as a nation, allowing NPs and PAs to practice medicine without standardized medical education. Let us not forget the Flexner report (addressing the public health crisis of unequal medical training and implementation to the public), that was presented in 1910, addressing the need for rigorous study and standardization of medical training. As such, medical education and training was completely transformed:

http://archive.carnegiefoundation.org/publications/medical-education-united-states-and-canada-bulletin-number-four-flexner-report-0

http://hsc.unm.edu/community/toolkit/docs/postflexner.pdf

Congress must also realize that they have contributed to this public health crisis by not increasing the required number of residency positions necessary to properly care for our nation:

https://www.aamc.org/newsroom/newsreleases/426166/20150303.html

https://vimeo.com/135609942

Many NPs can get their NP degrees online. The training of nursing programs, as well as nurse practitioner programs, are not standardized nor are they regulated. Physicians have, on average, a total of 21,000+ clinical training hours before practicing independently.  Nurse practitioners may only have 500-5,000 clinical training hours, depending on the advanced nursing program, of which most of the clinical training is observational:

https://www.midlevelu.com/blog/md-vs-np-vs-pa-heres-how-number-clinical-hours-compare

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354979/

The basic medical knowledge and training in medical school cannot be undercut. A 2^ndor 3^rdyear medical student (almost equivalent to the total amount of NP clinical training hours) would never be allowed to practice medicine independently. Not knowing what you don’t know can be very dangerous not only to the individual patient, but to the public. In the end, one should have the background and experience to practice the full scope of medicine independently.

The unintended consequences of permitting a nonphysician workforce to practice medicine without adequate supervision will be evident very soon if we continue to move in this current direction, thereby causing another public health crisis. Healthcare delivery will be unregulated and inadequate, posing significant and serious health risks in our patient populations. One can equate allowing NPs to practice unsupervised medicine to allowing a paralegal to practice law, or allowing a dental assistant to practice dentistry, or allowing security guard to act as a policeman. We may as well do away with medical school and all of the training, hard work, debt, and sacrifice.

There are only a handful of studies that have studied NP healthcare delivery and quality. One study only looked at diabetes treatment by nurse practitioners. This info is not nearly enough to justify NPs to practice medicine independently. Again, we must remind Congress, the state medical boards, etc. of the Flexner report and why medical education and training is what it is today. We must continue to create an enforce the laws to not only keep the patients safe, but also maintain the integrity of the medical profession.

Until next time,

Dr. Nicolle

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