Who was that person in the white coat that saw me today in the clinic? Should I have called them 'Doctor'??
For the last several decades what we are calling mid-level practitioners. have been present in a variety of settings. Various titles have been assigned to them dependent upon which route they took to become mid-level practitioners. Nurse practitioner, physician assistant. It is not so straight forward to telling you how advanced their training has been.
M.D.s and D.O.s normally have three or four years of undergraduate degrees leading to a bachelor's degree, followed by four years of medical school and then postgraduate training in a general or specialty area. Over time this training has evolved and become longer. Mid-level health personnel may have previously been R.N.s or taken a route to become a physician assistant in special programs. Some P.A.s may also become 'specialty PAs' serving as assistants to surgeons as extenders.
It becomes obvious a long white coat is no longer a beacon called 'doctor'.
This phenomenon has become more prominent due to organizations such as the. Veterans Administration Health System, the Department of Defense and some managed care institutions. The initial impetus was to increase accessibiliy when physicians are in short supply and/or over worked. A secondary gain has been some cost savings.
In all instances the mid level practtiner reports to a licensed physician. They do not practice independently.
: Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians' care compares in this setting.
Primary analyses included 23,704 patient visits to 1139 practitioners-a sample representing approximately 30 million patient visits to HCs in the United States.
Measures: We examined 9 patient-level outcomes: 3 quality indicators, 4 service utilization measures, and 2 referral pattern measures.
Results: On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care. On the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCMDs (P≤0.05). Visits to PAs also received more health education/counseling services than visits to PCMDs (P≤0.01; design-based model only).
Conclusions: Across the outcomes studied, results suggest that NP and PA care were largely comparable to PCMD care in HCs.
This study. is highly biased as it only surveys in FQHMCs. (Community Health Centers). The cohort of patients is almost 100% Medicaid, a statewide payer through a variety of managed care programs such as the Inland Empire Health Plan and Molina Care.
Both of these entities are not for profit plans, paid for entirely by state and federal medicare funds. These plans reimburse providers and hospitals amounts far below the usual and customary fees. Hospitals and providers are paid barely their cost to provide services. They could not exist without indirect subsidies by private payers.
The statistical results as to quality of care may be biased since the study is done by the entities themselves, to justify the use of mid level practitioners.
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