STUDY PROVES NON-PHYSICIAN CARE IS MORE COSTLY

“Targeting Value-based Care with Physician-led Care Teams: An important study debunks the myth that NPs and PAs are able to deliver a level of care similar to that of physicians.”

The Hattiesburg Clinic is a large multi-specialty group with dozens of locations and practices across southern Mississippi. In January of 2022, a study was published in the Mississippi Medical Society’s journal that refuted the commonly held misconception that APPs provide a level of care similar to that of physicians.

The retrospective study, titled “Targeting Value-Based Care With Physician-led Care Teams,” collected and analyzed almost a decade’s worth of data from the large Mississippi clinic’s electronic medical record.

They concluded what so many of us already know: NPs and PAs are important parts of a physician-led healthcare team, but SHOULD NOT practice independently or without supervision. There is a reason medical school and residency are long and arduous. The Johns Hopkins model of medical education has withstood over 100 years of challenges and growth in medicine. The model works.

The Hattiesburg Clinic set up its own similar FPA-like model with “collaborating” physicians and enabled nurse practitioners (NPs) to have their own patient panels. They then did what no state legislature, regulatory, or licensing body has ever done in any state with FPA… they followed up—10 years later. You know, to see if what they instituted was actually working. Mad respect for this institution.

There is no doubt in my mind that everything they did was in the best interest of their patients. That’s why they have the reputation they do, and it is well-deserved. If every FPA state and academic center were to do the same, I predict the results would be similar. With all due respect, I think the one mistake the authors made was in believing that there was “mounting evidence nationally that APPs could provide levels of care similar to that of physicians”.

“We allowed APPs to function with separate primary care panels, side by side with their collaborating physicians. Although necessity initially drove our decision to allow APPs to function in the primary care provider (PCP) role, we felt comfortable with this decision over the following years as there was mounting evidence nationally that APPs could provide levels of care similar to that of physicians.”

The reality is that there was no mounting evidence. It didn’t exist and still doesn’t. Physicians for Patient Protection (PPP) stated this years ago, and no one listened. Then, PPP documented and debunked the studies in their book, “Patients At Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare”. That information was then shared in the “Patients At Risk” podcast (https://youtu.be/yGeFGndEiwA) in three episodes. Bottom line, the studies the American Association of Nurse Practitioners (AANP) uses to push FPA are poorly done studies. I’ve often said that if docs took the time to review even one study, the shoddy methodology would be evident.

Unfortunately, when fiction is repeated often enough, it becomes fact. And no one checks the “facts”; they just believe. That is how FPA has progressed successfully -that and exceptional lobbying by the AANP. My perspective on the entire FPA movement is that it doesn’t make sense. I’m a chick with a lot of common sense. In my opinion, some things are so evident as not to require a study.

Nurses are not physicians, so how could they possibly have similar outcomes as physicians? Who would believe that s**t? Turns out, a lot of people do. And instead of asking NPs to prove what they claim with actual, respectable evidence, physicians are asked to prove a negative–that NPs are not qualified. Absurd.

“The practice of medicine is the gold standard by which all other disciplines of health provision are measured. The onus is on others to prove, with VALID evidence of sound quality and unquestionable standards and methodology, that their discipline measures up.”
—Yv Newman.

In other words, if one wants to practice medicine, the responsibility lies with one to prove he/she can do so effectively and competently. That didn’t happen with FPA. The one exam specifically developed for nurse practitioners with Doctor of Nursing Practice (DNP) degrees to prove their competency failed after 5 years of being administered. Nothing has replaced it since.

I believe every state with FPA has a responsibility to do what the Hattiesburg Clinic did (which I view as a microcosm of the enactment of FPA).

FOLLOW UP.

It is essential that someone take the time to evaluate and assess if FPA is working as purported. Oregon has had FPA the longest. Why hasn’t a review been done there? Or in Arizona, where FPA has been in existence since 1996? The Hattiesburg Clinic is probably one of the best examples of an MD/DO-NPP collaborative model. Yet, the results of their study were an eye-opener for them. 

“10 year review of Hattiesburg clinic shows decreased healthcare quality & patient experience, increased cost & resource utilization with ‘independent’ NPs.”
— @HalstedMD

Makes me wonder what we might see in less exemplary models…In any case, true to form, the Hattiesburg Clinic is changing its practice based on the results of its study. I would expect nothing less from such a clinic. Every institution should be as responsible and discerning. Kudos to them again. ☤