Unfortunately, this lower quality of training and clinical experience is beginning to become apparent. New studies are demonstrating that removing standardized curriculum and physician supervision from nurse practitioner training and practice is impacting the quality of patient care, including poorer quality referrals[i] to specialists compared to primary care physicians, more unnecessary skin biopsies[ii] than physicians, increased diagnostic imaging,[iii] increased prescriptions[iv] including increased antibiotic prescribing[v] and higher opioid prescribing shown in the states of Connecticut and New Hampshire. Payouts for malpractice claims against NPs are also on the rise, as are claims for the improper prescribing and management of controlled substances. With training programs churning out NPs at a rate of 23,000 per year, compared to about 19,000 physicians graduating from medical school per year, we may see these trends grow.
POPULAR ON OUR SITE: DPC is here to stay
As physicians and patient advocates, this should concern us. As we know, doctors receive 20,000 minimum hours of training before we are permitted to practice independently, and yet we often remain fearful of being unprepared or missing something. Nurse practitioners require only 500 clinical hours to sit for their boards, and are now permitted to practice without supervision in almost half the states in the union. Perhaps it is easier to feel confident when you “don’t know what you don’t know.” Unfortunately, this is not something that can be learned online.
Rebekah Bernard, MD, is the daughter of two Registered Nurses and a Family Physician in Fort Myers, Florida. She is the author of “How to Be a Rock Star Doctor.” She can be reached at RebekahBernard.com.
[i] Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners Lohr, Robert H. et al. Mayo Clinic Proceedings , Volume 88 , Issue 11 , 1266 - 1271
[ii] JAMA Dermatol. 2015;151(8):899-902. doi:10.1001/jamadermatol.2015.0173
[iii] JAMA Intern Med. 2015;175(1):101-107. doi:10.1001/jamainternmed.2014.6349
[iv] Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries Muench, UlrikePerloff, JenniferThomas, Cindy ParksBuerhaus, Peter I. et al.Journal of Nursing Regulation , Volume 8 , Issue 1 , 21 - 30