Magazine article Medical Economics

Are NPs and Primary Care Doctors Interchangeable?

Magazine article Medical Economics

Are NPs and Primary Care Doctors Interchangeable?

Article excerpt

A recent report says they are, but at least one doctor calls the results "far from convincing. "

Lary 0. Mundinger would answer a resounding Yes to the title question, based on her comparative study of doctors and NPs caring for a population of 1,300 patients. "NPs' and doctors' outcomes are indistinguishable in this study, so that would suggest that they indeed are interchangeable," says Mundinger, dean of Columbia University School of Nursing.

The patients, primarily Hispanics who sought health care through the emergency room or urgent care center at Columbia Presbyterian Medical Center in New York City, were randomly assigned to primary care doctors or to NPs in an independent practice with hospital privileges and prescribing authority. The NPs and physicians had identical productivity requirements. The study, published in the Jan. 5 issue of JAMA, was the first large-scale, randomized clinical trial of NPs and physicians in similar practices, according to Mundinger.

After six months, researchers evaluated the patients' health status and satisfaction with care. The results: No significant differences were found in outcomes for patients with diabetes and asthma, although hypertensive patients under the care of NPs had lower diastolic values. NPs and physicians hospitalized patients at the same rate and used the same amounts of services. On one of four aspects of patient satisfaction, scores were somewhat higher for the physicians, which Mundinger attributes to the NPs' being required to move their practice during the study.

"If NPs can care for a group of non-Englishspeaking, underserved patients and bring their health status up in six months, it's pretty easy to say that they can do a good job with any patients:' says Mundinger.

Not necessarily, writes internist Harold C. Sox in an editorial accompanying Mundinger's study. …

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