HATTIESBURG STUDY 

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The landmark study “Targeting Value-based Care with Physician-led Care Teams” published in the Journal of the Mississippi State Medical Association (2022) showed that having an NP or PA for primary care (PCP) resulted in:

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• Decreased quality - Physicians performed better than NPs/PAs in 9 out of 10 quality measures

• Increased cost - totaling $10.3 M per year for the organization 

• Increased ER visits - even though NP/PA patients were younger and healthier. Further, NP/PA patients were more likely to go to the ER than patients without ANY PCP.

• Policy change - The Hattiesburg Clinic no longer allows NP/PAs to act in a primary care role - all patients are seen by a primary physician, with NPs/PAs working under physician direction in a truly physician-led team

 

CHOOSING WISELY

 

While physicians are being urged to “choose wisely," research raises concerns about nonphysician practitioners' overuse of health care resources, with studies showing that NPs/PAs:

 

• Order more labs than physicians 

• Order more radiographic tests than physicians​​

• Prescribe more medications in general than physicians

• ​​Are easily influenced by drug reps - 96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event​

• Prescribe more opioids than physicians - NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states​

• Prescribe more antipsychotics to children than physicians

  • There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs and a 28.6% proportional increase by non-psychiatric NPs. By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined  ​

• Prescribe more unnecessary antibiotics than physicians​

• Place lower quality referrals than physicians

  • When caring for patients with diabetes, NPs were more likely to have consulted cardiologists, endocrinologists, and nephrologists ​

• Perform significantly more biopsies than physicians to diagnose skin cancer in patients < 65 years and fail to diagnose melanoma-in-situ more often than physicians

• Are more expensive than resident teams 

• Do not lower staffing costs 

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ANESTHESIA SAFETY

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(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625

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Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/

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