Despite concerns aired by doctors that advanced practice clinicians are redundant and prescribe unnecessary tests and treatment, researchers suggest they could become a key part of healthcare as more and more people gain access to services.
Researchers at the University of California Los Angeles found that, for a range of conditions and treatments, clinicians are no worse than doctors when prescribing low-value health services such as antibiotics for the common cold and x-rays, contradicting doctors’ concerns.
Although the new study shows doctors give slightly fewer of these low-value health services, the numbers are close enough that researchers say the concerns that clinicians, such as nurse practitioners and physician assistants, could damage healthcare are overblown.
The researchers point to expectations there will be a shortfall of as many as 20,000 doctors within five years, suggesting a need that, even now, could help make it easier for people to get the medical care they need.
“As advanced practice clinicians rapidly expand their role in primary care, these findings have important implications for clinicians, practice leaders, and policymakers who have a stake in improving access to primary care services and ensuring the delivery of high-value care,” Dr. Bruce Landon, a professor of health care policy and medicine, said in a press release.
For the study, published in the journal Annals of Internal Medicine, researchers analyzed data collected between 1997 and 2011 collected by the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, examining the outcomes from three health services commonly referred to as “low value,” antibiotics for upper respiratory infections, X-rays for upper respiratory infections and back pain, and MRI or CT scans for back pain and headaches, as well as physician referrals to specialists for the conditions, which is generally not necessary.
For antibiotics, the researchers found office-based doctors prescribed the drugs 48.7 percent of the time, compared to 51.9 percent of the time, with doctors in hospitals issuing the prescriptions 46 percent of the time and clinicians doing so 52.8 percent of the time.
For CT and MRI, clinicians in offices recommended them nearly half as often as doctors — 3 percent of the time, compared to 5.7 percent for doctors — although the difference between the two was less than 1 percent for those who work in hospitals. Clinicians request x-rays slightly more often than doctors, 10.9 percent of the time in offices and 11.1 percent in hospitals, compared to 10 percent of the time for office-based doctors and 10.5 percent of the time for those in hospitals.
The amount of times patients were referred to specialists in these types of situations was slightly higher for clinicians than for doctors — clinicians give referrals 7.8 percent of the time in offices and 11.8 percent of the time at hospitals, compared to 7.6 percent for doctors in offices and 8.3 percent in hospitals.
“We’ve known for many years that low value health services are being given to patients, yet despite that we still provide large amounts of it, which not only is bad medicine, but it also raises costs,” said Dr. John Mafi, an assistant professor of medicine at the University of California Los Angeles. “Our main finding, that nurse practitioners and physician assistants are no worse than doctors in this way, is reassuring in light of recent efforts to expand advanced practice clinicians’ scope of practice and while the primary care physician workforce continues to shrink.”
