Beyond the X-Ray:
Unveiling the Battle for Healthcare Excellence
The Problem
In recent years, in conjunction with the increasing corporatization of medicine, advanced nursing advocates and other nonphysician practitioner (NPP*) groups have aggressively sought to expand their professional constituency’s roles in medicine. This has resulted in the replacement of physicians (an MD or DO) with less trained, less educated health care practitioners. These advocates seek to change laws where, at worst, nonphysicians can potentially endanger patients by working far outside of their learned capability without ANY physician oversight, or at best, have nonstandardized so called “supervision” which may entail a distant offsite physician forced by their employer to sign charts without ever being allotted either the time or ability to actually see the patient in need.
*Please note that Nonphysician practitioner (NPP) is a factually accurate term and is also official terminology utilized by Medicare.
Why This Matters to You, the Patient
Efforts that result in less physician involvement with a patient’s care in favor of NPPs–such as awarding a Nurse Practitioner (NP) or Physician Assistant (PA) with expanded medical privileges, roles, and responsibilities – are misguided, inherently dangerous, and place unfair expectations upon the nonphysicians themselves. Despite these legitimate concerns, big corporations are squeezing physicians out of medical care teams with alarming frequency.
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Why? For purely financial reasons. To increase their own bottom line.
Putting profits over patients very predictably leads to higher costs and lower quality care for you, the patient.
Every patient rightfully expects that an appropriately trained medical expert with the necessary educational background will diagnose and treat them when they are sick and vulnerable. [1] Educational time and level of training are critically important when it comes to the health and safety of patients.
“We do not rise to the level of our expectations, we fall to the level of our training.” - Archilochus
A physician’s rigorous, extensively vetted, highly standardized educational pathway and vast (also standardized!) clinical experience render them uniquely qualified to lead the medical team and make complex clinical determinations for their patients.
1 AAFP Warns of Dangers in Bill to Expand NPPs’ Practice Scope. American Academy of Family Physicians. Published online November 9, 2022.
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The Facts
The data is clear.
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Completely removing the physician or even distancing the physician in lieu of a less educated NPP for the supposed quicker access to health care – or quite arguably, the illusion of access – actually results in increased costs to the patient, [2] increased unnecessary hospital visits, [3] not to mention issues of delayed diagnosis and misdiagnosis – all of which needlessly harm patients.
When NPP’s medical privileges and scope of practice are expanded at the expense of a physicians’ presence and involvement in patient care, studies show a resultant overprescription of drugs [4] and unnecessary use of specialists, [5] thereby also increasing
costs to patients. Data from the Veterans Health Administration (VHA) shows that patients cared for by NPPs without physician supervision had an 11% increase in hospital stay and resulted in 20% more preventable hospitalizations as compared to rates for emergency physicians. [6] Data from the VHA demonstrates how expanding NPP medical privileges are a poor substitute for the direct and unique patient-physician relationship. NPPs exhibited poorer decision-making regarding whom to admit to the hospital and/or hospitalized patients for a longer amount of time, with resultant lower standard of care and incurring a higher financial cost.
As NPP expansion of scope relates to radiology specifically, data once again indicates NPPs significantly increase cost to the patient as a result of overutilization as compared to physicians. Looking at skeletal radiographs from 2003 to 2015, the utilization rate for NPPs (primarily NPs and PAs) increased a whopping 441%! [7] And that’s just taking into account ONE imaging modality (radiographs only, not CT, MRI, etc) and even then, only a small fraction of ALL radiographs, just skeletal radiographs!!
This is simply yet another example illustrating why expanding the scope of practice and medical privileges for nonphysicians is very costly, lowers the quality of medical care provided, and ultimately hurts patients in multiple ways.
2 AAFP Warns of Dangers in Bill to Expand NPPs’ Practice Scope. American Academy of Family Physicians. Published online November 9, 2022. ​ 3 Chan, David & Chan, Yiqun. The productivity of professions: Evidence from the emergency department. NBER WORKING PAPER SERIES. October 2022. 10.3386/w30608 4 Lozada MJ, Raji MA, Goodwin JS, Kuo YF. Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns. J Gen Intern Med. 2020;35(9):2584-2592. doi:10.1007/s11606-020-05823-0 5 Lohr RH, West CP, Beliveau M, et al. Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners. Mayo Clin Proc. 2013;88(11):1266-1271. doi:10.1016/j.mayocp.2013.08.013 6 Chan, David & Chan, Yiqun. The productivity of professions: Evidence from the emergency department. NBER WORKING PAPER SERIES. October 2022. 10.3386/w30608 7 Mizrahi DJ, Parker L, Zoga AM, Levin DC. National Trends in the Utilization of Skeletal Radiography From 2003 to 2015. J Am Coll Radiol. 2018;15(10):1408-1414. doi:10.1016/j.jacr.2017.10.007
The Bottom Line
Nonradiologists and other skilled medical professionals who are not physicians are important members of the medical team providing safe and effective care to patients. However, there are no shortcuts to safe, high quality medical care. NPPs cannot and should not do it alone nor with inadequate supervision. A patient’s well-being must be the highest priority, and a physician-led team is the best way to deliver dependable, safe, and cost-effective care. [8]
Every Oklahoman expects – and deserves – physician led care.
Here at OSRS our primary goal is and always has been to promote the best possible care for our patients – our friends, our neighbors, our fellow Oklahomans. Each and every physician went into the profession of medicine to care for YOU, for our PATIENTS. At our core, we are helpers. We adhere to our Hippocratic Oaths and strive to promote our core beliefs relating to beneficence and non-maleficence.
We are your advocates.
8 Chan, David & Chan, Yiqun. The productivity of professions: Evidence from the emergency department. NBER WORKING PAPER SERIES. October 2022. 10.3386/w30608
