Nurse Practitioners, Physician Assistants Playing Larger Roles In Health Care — Why Some Doctors Are Pushing Back
When nurse Payal Patel changed doctor's offices, she accompanied patient Nee-Ima Latimer. The Hampstead woman said she felt more comfortable with him and other nurses than with doctors.
"He treats me like a patient person, not just another case or number," said Latimer, 39, who has lupus.
Patel is one of the most With 41,000 nurses in New York City, it is one of the fastest growing health care professions.
Many patients who previously went to a doctor for routine care now often turn to nurse practitioners, or medical assistants, who are increasingly playing a key role in hospitals. The growing number of registered nurse practitioners and physician assistants is linked to a chronic shortage of primary care physicians.
"When there is a shortage of primary care providers, people lack access," said Patricia Bruckenthal, dean of Stony Brook University's School of Nursing. "It gives people an opportunity to expand their access to health care and get the services they need." »
Renee McLeod said the growing role of nurse practitioners and physician assistants is driven by an increase in the overall demand for health care as an aging population needs more health care and the Affordable Care Act expands health insurance to more people. -Sorjan, dean of the Hofstra Northwell School of Nursing and Physician Assistants.
Some studies show that nurse practitioners and physician assistants provide care comparable to physicians in some cases. But groups representing doctors say they need medical supervision, especially in the most difficult cases, and oppose attempts to increase their autonomy.
"A doctor should be a team leader," the doctor said. Paul Pipia, president of the New York State Medical Society and associate medical director of Nassau University Medical Center in East Meadow.
Organizations of nurses and paramedics say there is no need for supervision.
"We're asking to do what we've been taught," Ed Mattes, president of the New York State Society of Physician Assistants, said of the state's bill to reduce oversight.
The number of registered nurses in New York more than quadrupled from 8,948 to 41,160 between 2000 and Jan. 1, according to the state Department of Education, which issues licenses for the profession. The number of paramedics grew at the same rate from 2000 to Jan. 1, from 5,347 to 22,725, according to state data.
In contrast, the number of licensed physicians grew at a slower rate, from 72,004 in 2000 to 111,167 on January 1: a 54% increase.
The nurse practitioner and physician assistant professions were created in the mid-1960s to improve access to health care. Nurse practitioners and physician assistants, or PAs, often called NPs, can prescribe medications, make medical diagnoses, and perform other tasks that doctors see but that nurse practitioners and other healthcare professionals do not.
About half of the states require that nurse practitioners work under the supervision of a physician. In 2022, New York eliminated this requirement for nurses with more than 3,600 hours of experience. A bill in the state Legislature would allow skilled physician assistants to work without physician supervision, which groups representing physicians oppose.
At the state-funded Harmony Medical Center in Hampstead, where she works, Patel said there are no rules about which patients see a doctor and which see a nurse.
His approach, he says, goes beyond the medical reasons patients see him.
"In NP school, we're taught more holistic care," Patel said before entering an exam room at Harmony to check on Latimer.
Lattimer, who has lupus, regularly sees specialists outside of Harmony.
"My experience with doctors is that they just come in, look at your medical records and say, 'It's fine.' Is everything okay?' And then bam, they're gone," he said.
Nurses like Patel asked more questions and were more approachable, which encouraged her to be more open about her health issues, she said.
“Nurses are more personal,” she says. "They are here to meet your needs."
Shakena Smith, 40, of Wyandotte, is a patient of Dr. Harmony Shira Kravets. Smith said she understands Kravets is not a doctor, but calls him "Dr. Wide" and doesn't see much of a difference in the care she receives from him and the Harmony doctors.
"I don't really look at their letters and abbreviations," he said. “Your patient care is outstanding. »
Rebecca Charles, Harmony Health's chief operating officer, said nurse practitioners and physician assistants allow Harmony to better serve its patients, many of whom are uninsured or underinsured.
"We have a lot of patients," he said. “NPs and PAs allow us to see more of our patients and avoid long waits for appointments. »
Nurse practitioners and physician assistants can also save health care systems, says Dr. Cameron Gettel, a professor of emergency medicine at Yale School of Medicine who studies the health implications.
Nurses and physician assistants are typically paid less than physicians, which can lead hospitals to rely more on them than physicians.
Professor and former dean Eileen Sullivan-Marks said the pay gap is narrowing because some experienced nurses earn more than pediatricians, family doctors and others with less experience. from New York University's Rory Meyers College of Nursing in Manhattan.
According to the state Department of Labor, the median salary for a registered nurse on Long Island was $188,152 in 2023, just below the family physician salary of $199,647. Physician assistants earned an average of $153,263. The gap is even wider when comparing NPs and PAs to specialists, some of whom earn twice as much on average as primary care physicians, according to national surveys.
Sullivan-Marks said the main reason for the increased demand for nurse practitioners and physician assistants is that health systems today take a more "team approach" to things, especially more complex cases, and rely more on technology.
"It's the sole duty of a physician to do all of that -- that's not the way health care is delivered today, given all the technology in health care," he said.
According to her, more emphasis is placed on emotional support of patients, which is often coordinated by nurses.
Nurse practitioners in New York must choose a specialty such as family health, pediatrics or psychiatry, while physician assistants train as family practice physicians, said Donna Ferraro, director of the physician assistant program at Stony Brook.
Another difference is that health professionals are trained more, like doctors, to focus on the respiratory, digestive and other body systems, and on symptoms specific to those systems, says Ellen Kurtzman, a professor of health care management at Rutgers University in New York. Jersey. . . . According to him, in addition to clinical training, nurses will undergo more intensive training in the field of prevention and health promotion.
Starting in 2022, New York nurses with more than 3,600 practice hours will no longer need to see a physician, though McLeod-Sorjan said there are still hurdles, such as Medicare rules and some insurance companies not allowing reimbursement. when a nurse provides medical care. . he said. initial diagnosis.
In addition, another Medicare rule pays nurse practitioners and physician assistants 85% of the amount they receive if they bill the government independently, and 100% if they use a physician's billing number and the physician is present during the patient's visit. . According to Bruckenthal, the costs to the patient are the same.
Physician assistants fought unsuccessfully to repeal the medical observation requirement.
Gov. Kathy Houkul's fiscal year 2025 budget would eliminate supervision of physician assistants after 8,000 hours of work experience, as well as some additional requirements beyond primary care.
The bill, backed by the Society of Physician Assistants, would set the practice limit at 3,600 hours, though Mattes said the organization would be willing to compromise.
Oversight limits patient access because state law limits the number of health care providers a doctor can supervise, which can lead to staffing problems, he said.
The doctor's assistants said that he was already under the control of the doctors. Matts recalls that years ago, the new top doctor in Rochester banned him from performing lung biopsies, even though he had already performed about 2,000 biopsies.
"That doctor said, 'Well, that's not a procedure that a PA should be doing,'" she said.
The New York State Medical Society and the American Medical Association, which represent physicians, opposed giving more autonomy to paramedics and nurse practitioners.
Pipia said a doctor has more education and training, with four years of medical school and at least three years of residency training, compared to a master's degree for nurses and paramedics, which typically takes two to three years.
"I don't think the training gives them the knowledge to work independently."
Some studies have found no difference in the care provided by nurse practitioners and physician assistants compared to physicians, although experts say physicians are better at handling more complex cases.
A 2017 study found no statistically significant differences in care at community health centers. The exception was that physician assistants, and especially nurse practitioners, provided more medical education and counseling than physicians, said study co-author Kurtzman.
According to him, other studies have shown similar results in doctors' offices and hospital clinics.
But a large 2022 study that did not look at Veterans Affairs emergency room patients found that patients had worse outcomes, such as shorter hospital stays. "preventive" - for nurses compared to doctors.
Gettel, the Yale professor, said "the data on emergency department outcomes is somewhat mixed," with some studies showing no difference. According to him, one of the reasons for these conflicting results is the difficulty of making direct comparisons between the types of patients treated.
According to Gettel, doctors are preferred in more serious emergencies because of their higher level of training.
Kurtzman said if he goes to the emergency room with a sore throat, a sore leg or a urinary tract infection, he "would have no problem seeing a nurse." But when I have chest pain: "I hope the person who treated me was a doctor."
Kravets, Harmony's health care worker, said he usually has to see a doctor, but sometimes calls his primary care physician for more complicated cases.
"Sometimes they are difficult patients and there are things I haven't seen before, things I'm not sure about, and I always have that support," she said.
When nurse Payal Patel changed doctor's offices, she accompanied patient Nee-Ima Latimer. The Hampstead woman said she felt more comfortable with him and other nurses than with doctors.
"He treats me like a patient person, not just another case or number," said Latimer, 39, who has lupus.
Patel is one of the most With 41,000 nurses in New York City, it is one of the fastest growing health care professions.
Many patients who previously saw a physician for routine care now often turn to nurse practitioners, or medical assistants, who increasingly play a key role in hospitals. The growing number of registered nurse practitioners and physician assistants is linked to a chronic shortage of primary care physicians.
WHAT YOU NEED TO KNOW
The number of nurse practitioners and physician assistants in New York City has quadrupled since 2000 as outpatient practices and hospitals increasingly rely on them for patient care.
Registered nurses and physician assistants can perform the same tasks as doctors, such as prescribing medications and making medical diagnoses.
The state expects that the number of nurses and paramedics will continue to grow faster than the number of doctors . According to experts, as medical demands grow amid an aging population, access to health care is improving.
"When there is a shortage of primary care providers, people lack access," said Patricia Bruckenthal, dean of Stony Brook University's School of Nursing. "It gives people an opportunity to expand their access to health care and get the services they need." »
Renee McLeod said the growing role of nurse practitioners and physician assistants is driven by an increase in the overall demand for health care as an aging population needs more health care and the Affordable Care Act expands health insurance to more people. -Sorjan, dean of the Hofstra Northwell School of Nursing and Physician Assistants.
Some studies show that nurse practitioners and physician assistants provide care comparable to physicians in some cases. But groups representing doctors say they need medical supervision, especially in the most difficult cases, and oppose attempts to increase their autonomy.
"The doctor should be the leader of the team," said the doctor. Paul Pipia, president of the New York State Medical Society and associate medical director of Nassau University Medical Center in East Meadow.
Organizations of nurses and paramedics say there is no need for supervision.
"We're asking to do what we've been taught," Ed Mattes, president of the New York State Society of Physician Assistants, said of the state's bill to reduce oversight.
The number of registered nurses in New York more than quadrupled from 8,948 to 41,160 between 2000 and Jan. 1, according to the state Department of Education, which issues licenses for the profession. The number of paramedics grew at the same rate from 2000 to Jan. 1, from 5,347 to 22,725, according to state data.
In contrast, the number of licensed physicians grew at a slower rate, from 72,004 in 2000 to 111,167 on January 1: a 54% increase.
New York state laws expand autonomy
The nurse practitioner and physician assistant professions were created in the mid-1960s to improve access to health care. Nurse practitioners and physician assistants, or PAs, often called NPs, can prescribe medications, make medical diagnoses, and perform other tasks that doctors see but that nurse practitioners and other healthcare professionals cannot.
About half of the states require that nurse practitioners work under the supervision of a physician. In 2022, New York eliminated this requirement for nurses with more than 3,600 hours of experience. A bill in the state Legislature would allow skilled physician assistants to work without physician supervision, which groups representing physicians oppose.
At the state-funded Harmony Medical Center in Hampstead, where she works, Patel said there are no rules about which patients see a doctor and which see a nurse.
His approach, he says, goes beyond the medical reasons patients see him.
"In NP school, we're taught more holistic care," Patel said before entering an exam room at Harmony to check on Latimer.
Lattimer, who has lupus, regularly sees specialists outside of Harmony.
"My experience with doctors is that they just come in, look at your medical records and say, 'It's fine.' Is everything okay?' And then bam, they're gone," he said.
Nurses like Patel asked more questions and were more approachable, which encouraged her to be more open about her health issues, she said.
“Nurses are more personal,” she says. "They are here to meet your needs."
Shakena Smith, 40, of Wyandotte, is a patient of Dr. Harmony Shira Kravets. Smith said that it is not a port, but it calls it a "doctrine of the broad" and does not see the big spit in the entry, which it gets from it and the Harmani. .
"I do not wake up on them and scrapers," said he said. “Your focus on patients are free. »
Drabekka Charles, Home Operational Director Harmony Health, said that practicing nurses and helpers can allow Harmony to do with their patients, many of which are not enlarged.
"We have many patients," he said. “NP and PAs allow us to take over our more patients and run away. »
Economy on the Sisthem
Practical nurses and helpers of the clerks also can spasts the system of treasury, the doctor speaks. Cameron Hettel, Professor Unotlonted Medicine of the Yelsky Medical School, Expressing Condition for Health.
The wages of the nurses and the assistants of the deeds are despite the bottom, which in the deeds that can be taken to the fact that the hospital will be more overwhelmed on them, not on the deeds.
Professor and ex-Decan Eilin Salivan-Marx said that breaking the salary plate is scratching, because some of the experienced nurses earn more than pediatters, seeds and other people with the lessons. From the Colleja Nursing Names of Rori Meyers New Yorks University on Manhattan.
According to the state staff of the state labor, the average salary of the diplomed nurse on the Long Island in 2023, it was $ 188 152, which is a number of salaries of the family in 199 647. The help of the centers earned in the middle of 153 263. The rupture is more, if it is possible to do with the NP and by specialists, some of which in the middle earn more than the more than the primary medical help, as the national sketches.
Salivan-Marx said that the basic reaches of the elderly attempt on the nurseries and the help of the clerks is concluded in the fact that the system of treasury today takes a "fantasy". legs.
"The unification dispensing of the inception of the way - this is not the safety of the medical help today, learning all the technologies in treasury," said he said.
In the word, the greater emphasis is on the emotional subderz of patients, which often coordin the nurses.
Practical nurses in New York should choose such specialty, as a family health, pediatry or psychiatry, in the case, as the assistants of the deepening pass as a semeyan. Tov of the horn in Stone-Brook.
More united, Ellen Kurtman, Professor Management of Human Renovation in the University of Rutgers in New Gersi, is concluded in the volume that the workers are more than more, as it is. Flax and other systems of organism, as well as on symptoms characteristic of these Sistme. . . . According to him, the memory of the clinical lining, the nursing will be more intensified in the area of profilactic and seizure of health.
Debate Ob autonomies
Nachin with 2022 New York Nurses with more 3600 Sometimes projects will not be more likely to be in the widespread of the old man, the macleod-sorjan said that everything is still in the presentation, so as the right the interpretation of expenses, when the nurses The medical assistance is raised. . He said. Personal diagnosis.
The cruming of the one, more one of the midicare, paid the practical nurses and helps 85% of the sum, which they make, if they are exposed by the state of the independence, and 100%, when the no. t at the time of the Patient Visite. . According to the bruque, the costs for the patient are the same.
The help of the clerks uncushively boroli for the use of the treatment of medical inflows.
Katie Howcules Governor Katti Howcules for the 2025 financial year predisatory the predatory of the help of 8000 temporal experiences, and some of the rye -topics, coming behind the frames of the Persian Medicine Patrons.
The proof, the subordinate community of the help of the clerks, the establishment of the Limit of the projects on the heavily 3600 temporal, however, said that the organization would be ready on the compromise.
According to his word, the supervision is enclosed by the access of patients, the law of the state's law enters the number of post -centers of medicals, which can be covered by the fact that it is possible to hide to the sketch.
The aid of the Opinion said that he had already come to the authorities. Mats will mind that a lot of years ago a new Home Brand in Rochester forbidden him to carry out biopsy, however, he has already made up 2000 biopsies.
"This dear said, 'Well, this is not a process that is supposed to do," she said.
Medicine Society of New York and American Medicine Association, introduced by the tuft, performed against the most autonomies of the Felder and practiced medical center.
Pipia said that there was a more high education and luggage: the four years of wrapping in the medical school and as a minimum of three years of medical order on the steppe of the Master for the nursing and the peldzer. and years.
"I do not think that the shutter gives them know for self -work."
Examination of results in the attitude of health on the prediction with
Some studies did not disagree in the exit, we are distorted by practicing nurses and felders, by the prediction with the vrachi, the experts say that it is better to handle the verbal servant.
The study of 2017 did not reveal the statistical significant calculations in the general medical centers. Exclusion was that the assists of the clerks, and the particularly practicing nurses, presented more medical education and consulted, what the counselor spoke.
According to him, the other examination showed similar results in the cabinets of the acts and the hospital clinics.
New large examination, conducted in 2022, in which the patients did not dissolve the unattiver's help on the veterans, indicated that the patients had thunderstorms. "Pre -trial" - for the nursing on the deeds with the acts.
Hettel, Professor Yelsky University, said that "the data of the work of the unattached aid is not unique", and they did not indicate any science. In the word, one from the maintenance of these anticipiles, there is a phrase of the conduct of the presence of the intended patients.
According to the hettel, in the more sulfuric wrecking situations, the pre-pretending to find out the highs of their high levels.
If they are extinguished in the detachment of unattached helps with a bache in the throat, a pain in the legs or infection of the urinary paths, in the "without the problem will be enrolled to the medical center", said the Curtonman. But if I have a bolit of the breast: "I hope, a man who was lechil, was a barn."
Port, Feldcher Harmoni, said that her, her, she would come to the wrath, newly enlightened to the acquisition of the lords.
"Note these are the flags, and there are vechers that I have not seen in which I have not been conferred in, and I always have such a suprazhka," she said.
David Olson consecrate the question of treasury. He works in Newsday from 2015 and wounded the emigration, multiculturalism and religion in the press-anterprise in the Summer California.
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