Independent Nurse Practitioners and Physician Assistants: A Doc's View

Section 5 of President Trump's directive on protecting and improving Medicare includes rule changes that invert the current care delivery model for nurse practitioners (NPs) and physician's assistants (PAs), writes Medscape contributor Dr. John M. Mandrola. The revisions eliminate supervision of both positions and require "reimbursement parity" so Medicare dollars and ultimately all third-party care payments will be evenly distributed among doctors, NPs, and PAs. "It's less costly to employ NPs or PAs instead of a doctor," Mandrola notes. "What's more, adding less experienced clinicians in the current fee-for-service model is a feature, not a bug." Despite concerns from physicians that NPs and PAs lack the necessary medical training, studies have found few differences between nurse-led and physician-led care in many cases. In addition, easily grasped technology like point-of-care ultrasonography can help NPs and PAs deliver care on a level comparable to doctors. Mandrola also sees no reason why NPs and PAs cannot coordinate team-based care as well as any physician.