The Medieval Guild in Modern Health Care

The critical factors limiting nurse practitioners’ capacity to practice to the full extent of their education, training, and competence are state-based regulatory barriers. States vary in terms of what they allow nurse practitioners to do, and this variance appears not to be correlated with performance on any measure of quality or safety. There are no data to suggest that nurse practitioners in states that impose greater restrictions on their practice provide safer and better care than those in less restrictive states or that the role of physicians in less restrictive states has changed or deteriorated.

Full article from The New England Journal of Medicine available here.

Comments (7)

Trackback URL | Comments RSS Feed

  1. steve says:

    This has potential, but needs some work. After years of working with various advanced practice nurses and PAs, I find few ready to work independently when they finish training. The shortened training period means they often do not have enough clinical experience. After 2-3 years, they are usually up to speed. During that 2-3 years, they work well, but often need some help. If we can ignore the militants on both sides and set up a system that lets NPs get that experience before they move on to more independent work, this can work for some areas.


  2. Ken says:

    Steve, I can agree with everything you are saying and still believe we don’t need government telling everyone what to do. Regulations are holding people back — unnecessarily so.

  3. Tom H. says:

    I’m with Ken. We don’t need a guild system to promote high quality care.

  4. steve says:

    So you advocate for a 19th century approach where anyone who wants to can set up a practice in anything? Caveat emptor!


  5. politicaldoc says:

    It is well known that nurses don’t want to see NP’s or PA’s for their medical care no matter the amount of experience of the mid-level provider. Nurses are smart enough to request the doctor when they make appointments.

    Nurses are trained to treat symptoms and not as well trained to diagnose.

    If there is a choice involved, would anyone prefer to see a non-physician for his/her medical care?

  6. Ian Kodanik says:

    PAs are becoming more and more common. I would not mind were the quality of care rising. I’m never fully sure how that works; i.e., how much latitude the PA has or how much management is employed by the M.D. or D.O. But for run-of-the-mill illnesses, PAs and nurse practitioners, given a true market, could be a great solution. Given a market and could be.

  7. John Goodman says:

    In “Capitalism and Freedom,” Milton Friedman made a persuasive case that the proper role for government with respect to all the professions is to certify, not regulate.

    Through certification, government alerts the consumer about its judgment with respect to the skills and competency of the seller/provider. But the consumer is left free to contract with the provider of choice.