Episode 103: Do Nurse Practitioners Put Patients at Risk? Dr. Rebekah Bernard

Since 2010, the number of nurse practitioners in the United States has grown from 109,000 to 290,000. This explosion in growth is quickly transforming the health care landscape in the United States. But is it improving overall health? Is it providing more care for patients? Is it allowing for improved access? Is the quality improved or at least the same with physician-led care? Does that solve the problem of rural care?

These questions are the ones Drs. Rebekah Bernard and Niran Al-Agba attempt to answer in their book, Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare. The hypothesis of the authors is that despite healthcare's many failings in the US, the introduction of more nurse practitioners and physician assistants does not positively answer any of those questions. In fact, the authors contend, the explosion of these practitioners can hurt patients.

There is a huge economic incentive for hospital systems to promote and hire these professionals. First, they tend to be much less expensive to train and command a much lower salary than doctors. Second, in states where they have been given the ability to practice medicine with autonomy, they can be a cheap way to increase a referral base for a large hospital system. Third, as a part of the usual medical practice, PAs and NPs tend to order more tests and referrals to specialists which help hospital systems pad their bottom line.

However, the question that remains to be answered is if they improve health or are good for patients. Here, Dr. Bernard pushes forward anecdotes and studies to support the argument that NPs and PAs are best when collaborating with a doctor and not working independently. They set out guidelines they believe every patient should follow when seeking care in a hospital or clinic. Also, they lay out what solutions should be sought out by legislators and doctors to solve today's problems in health care. Finally, the book ends with a rather exhaustive list of objections to the arguments made by their critics.