'Why Not NPs and PAs?'
Physician Howard Spiro, who is the editor of The Yale Journal for Humanities in Medicine, argues that current model of physician education is outdated.
The coming of “evidence-based medicine,” which is the sifting of research and clinical reports to come up with published guides for clinical practice, has the potential to enlarge even further the army of what is optimistically labeled “health-care” givers, the physician associates and assistants, and nurse practitioners. Will there be a need for so many extensively trained physicians, when technology helps those less skilled get the same results? How will the public accept non-physicians as independent care-takers?
Given “rule-based” guidance and technological advances, should we think about changes in how medical students are selected and educated in the 21st century? M.I.T. Professor William Holstein in the New York Times of December 31, 2006, cautioned, “We haven’t moved the health care profession into a world where nurses can provide diagnosis and care.” His intent is to reduce costs, but he could be hinting politely that most physicians even now are over-qualified for what they do.
PA and NP education, he suggests, may be more relevant to today's clinical realities.
There is more to come. Physicians will shortly be required -- and may even be paid extra -- to follow rules of an evidence-based menu. All the more reason to wonder whether the long-standing emphasis on basic science serves any practical purpose in a guild guided by rules. Physician-extenders can surely care for most patients with easily recognizable complaints; not every health-care worker needs to be trained as extensively as in the past.
Link
PA and writer Brian T. Maurer has several essays and poems on the journal's Web site.
Link to YJHM home page