Are Nurses the Answer?
Adding nurse practitioners to a doctor’s office, it turns out, sometimes is less cost-effective than adding a new physician. That’s the surprising finding from health-care economists Nan Liu and Thomas D’Aunno in a new article in the Health Research Service.
How, exactly, does adding a lower-paid employee make a doctor’s office less productive? A lot of it has to do with the limits of what a nurse practitioner can do. State laws often require a physician to supervise a nurse practitioner, leaving that doctor with less time to see patients.
More from Sarah Kliff at Ezra’s blog. Also see Jason Shafrin on the same study.
Surprising.
Very counter intuitive.
What was the doctors’ conclusion? Was it that nurse practitioners are only productive when they are prevented from practicing independently and required to sell their labor only to physicians, who then bill for their patient visits and pay them a fraction of their patient revenue? If so, this sounds a little self-serving!
One thing that comes to mind: we really don’t know the exact worth (in dollars) of a physician’s time or that of a nurse practitioner. Absent a market free of government manipulation and price controls, it is very difficult to determine how productive each profession actually is. Concierge medical practices are informative, but they do not exist in a vacuum.
In a free market, doctors’ salaries would likely be lower but so would their overhead. In addition, they would look for patient-pleasing services (like email and web visits) and increase consumer satisfaction and reduce costs.
A study for, I believe, the NHS, found that nurse physician extenders ended up costing the same or more than physicians because their productivity was considerably lower. They simply took more time to do things than physicians. Lower pay was offset by lower productivity.
The study didn’t look at follow-on costs.