By Bob Sweeney
We’ve been exploring and commenting on the forces that seem to be relentlessly disengaging practicing physicians from the career satisfaction they anticipated when they chose clinical careers. Here is a ubiquitous force—the arrival of physician extenders into nearly every corner of physician practice.
Here are a few summary figures about the nurse practitioner field:
Let’s take a quick snapshot of the other extender profession, physician assistants:
There are many reasons, both economic and clinical, for the growth of these professions. Most physicians recognize that there are many functions in medicine that can be well executed by less highly trained and less costly clinical personnel—such as NPs and PAs. However, there are profound side effects from the growth of these professions that affect the physician’s sense of self-worth. For example, any primary care physician feels committed to continuity of care with respect to his/her patients. When the physician loses control of part of the diagnosis and treatment environment, there can be a real sense of disenfranchisement. Even physicians in specialties aimed at more immediate and short-term interactions with patients—such as emergency medicine– can feel diminished if their control of the engagement is subject to invasion or infringement. A secondary side effect is the threat to physician incomes from the loss of revenue from non-acute but well-insured patient encounters.
The impact of the extender in medicine requires that medical schools, residencies and specialty societies devote attention and resources to preparing physicians for a radically changed environment. The United States has benefited for over a century from its distinctively high quality medical care delivery. How do training and membership institutions, as well as society at large, address the potential threat to those standards from physician disenfranchisement, whatever the cause?
Robert E. “Bob” Sweeney, DA, MS