Letter: Patients prefer—and deserve—to be treated by the best and most highly trained physicians


To the Editor:

We agree with the concern expressed in “Study finds that nearly half of New Yorkers’ primary care providers are not physicians” (Aug. 31) that a shortage of primary care physicians in New York has resulted in an increased number of patients having a nurse practitioner or physician assistant as their primary care provider.

Patients should make decisions with a highly qualified physician who has rigorous training—including four years of medical school and three to seven years of residency and fellowship training—compared to a non-physician without that level of expertise. The future of health care is team-based care—and physicians should be the leader of that team.

The solution to this problem, however, is to make New York a more welcoming environment for providing medical care, not further empowering various health care providers with far less training. New York trains the highest number of physicians in the U.S. Still, we cannot retain them to practice in New York because, according to a WalletHub study, New York is the second-worst state for doctors to practice medicine.

New York’s liability insurance costs and other practice overhead far exceed those of most other states in the country. According to data from the Association of American Medical Colleges, more than 50% of residents trained in New York have left the state.

Moreover, studies have shown that treatment by non-physician practitioners is more costly to the health care system.

A recent study reported by the American Medical Association finds that when non-physicians are permitted to practice independently, this difference in training increases health care costs and patient safety risks. An examination of 10 years of cost data on 33,000 patients by the South Mississippi system’s accountable care organization of physicians and independently practicing PAs and NPs found that care provided to patients exclusively by NPs and PAs was much more expensive than the care delivered by physicians.

The study, which analyzed care provided by non-physicians at the Hattiesburg Clinic, found that NPs and PAs ordered more tests and referred more patients to specialists and hospital emergency departments than physicians.

Overall, the cost to the clinic for care provided by non-physicians could translate to $10.3 million more in spending annually if all patients were seen only by non-physicians. The data also showed that physicians performed better on nine of 10 quality measures, including double-digit differences in flu and pneumococcal vaccination rates.

When you remove the most highly educated and trained health care professional from the care team, you put patients at risk.

Other peer-reviewed studies have found that non-physician practitioners order more diagnostic imaging than physicians do for the same clinical presentations. A study in the American Journal of Radiology that analyzed skeletal X-ray use for Medicare patients found a 400% increase in ordering by non-physicians who were primarily NPs and PAs.

Patients deserve and prefer health care led by physicians. A recent AMA national survey found that it is important to 95% of patients that a physician be involved with their diagnosis and treatment decisions.

Policymakers should take steps to ensure that New York is a more welcoming state to physicians rather than expanding access to care by those with less training.

Dr. Parag Mehta is president of the Medical Society of the State of New York.

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