Will Mid-Level Practitioners Steal Our Business?

I’ve often written on the shortage of physicians in the US. Recently, Sarah Kliff posted on the upcoming debacle that might result if we don’t soon increase the numbers of primary care docs. One thing that might help is if we employed more mid-level practitioners, like nurse practitioners. This is opposed by a number of physician groups:

In its 2010 report, “The future of nursing: leading change, advancing health,” the Institute of Medicine recommends the removal of scope of practice (SOP) barriers for advanced practice registered nurses (APRNs) such that they can “practice to the full extent of their education and training” (IOM, S-4). Currently, only 16 states and the District of Columbia (DC) allow APRNs to practice independently of physicians…

In response to the IOM recommendation, the American Medical Association and the American Academy of Family Physicians, among others, have expressed their opposition, pointing out that physicians have more extensive education and arguing that nurses are not substitutable with primary care physicians. While the question of whether there are economic interests that might be negatively impacted by reforms is rarely discussed openly, the perceived impact of reform, particularly on primary care physicians, undoubtedly has and will continue to play a role in whether and to what extent SOP laws are reformed.

So it would be great if someone actually studied whether such laws impact how much docs might make. Well, someone did:

In this analysis, we compare the earnings of primary care physicians (family and general practice physicians and general pediatricians) to the earnings of surgeons. We assume that because primary care physicians’ practice overlaps with that of APRNs, in particular nurse practitioners, whereas surgeons’ practices do not, any effect on earnings from increased nursing autonomy would appear among the former two groups without effecting surgeons’ incomes. It is important to note that while a small number of APRNs may be certified as first assistants in surgery, this is not an area of independent APRN practice and, as such, would not be affected by variations in SOP laws.

So what did they find? The average earnings for FPs and GPs in states where there were no restrictions on mid-level practitioners (full SOP) were $79.36 per hour, compared to $81.15 in states with more restrictions. The difference was not statistically significant. The average earnings for primary care pediatricians in full SOP/no restriction states were $83.94 per hour, compared to $78.43 per hour in more restrictive states. Again, that wasn’t significantly different. Surgeons earned $107.23 per hour in no restriction states, versus$103.85 on more restrictive states (again, no difference). So bottom line – there was no difference. Allowing more mid-level practitioners to practice freely and independently was not associated with physicians earning less.

In the interest of full disclosure, I’m married to a nurse practitioner. So I may be biased in my assessment that she’s amazingly talented. But for those physicians who are worried that increasing the ability of mid-level practitioners to work independently might negatively impact their income, that doesn’t necessarily seem to be the case.

[Cross-posted at The Incidental Economist]