Your voice: Expanding the roles of NPs and PAs will make primary care more desirable

Senior editor Jeffrey Bendix’s comments in “Non-physician providers can help lower care costs for complex patients” (July 25, 2019 issue) will be met with derision by some primary care doctors.

Why? For two reasons.

First, some primary care physicians feel that their incomes will suffer if nurse practitioners and physician assistants provide primary care services. Second, others consider it demeaning that non-physician providers are considered capable of providing primary care despite their fewer years of training.

But the traditional training of primary care doctors-4 years of pre-med, 4-5 years of med school, and three years of residency-turns out physicians who are over-trained for what is required.

Primary care doctors no longer take care of hospital patients or nursing home patients. They don’t treat patients in the emergency room; and they rarely do gynecology or office surgery.

Most of their work includes treating upper respiratory diseases, hypertension, diabetes and coordinating care with specialists-not to mention the time- consuming, frustrating, administrative work that drains their energy and mental stamina and makes many feel like medical drudges.

One way to solve this predicament is to encourage nurse practitioners and physician assistants to join the primary care work force, and provide the services for which they were trained. This will reduce the workload per provider, reduce burnout, reduce frustration-it may even make a career in primary care desirable.

Although many practice in a collaborative role with physicians, in many states nurse practitioners are licensed to practice independently.
 
Edward Volpintesta, MD
Bethel, Conn.

Patients demanding convenience means trade-offs

In response to the article “Patients Demand Convenience” (June 25, 2019 cover story):

There is a sign in my nurses’ work area that says the following: “We offer three kinds of services: Good, cheap or fast. But you can choose only two! Choose Wisely!”

Cheap and fast won’t be good. Fast and good won’t be cheap and good and cheap won’t be fast.

I first saw this in a non-medical office 30 years ago. It still applies today, in any business-including medicine.
 
Choose wisely, indeed!

Jon Ahrendsen, MD
Clarion, Iowa