Nurse practitioners (NPs) are non-physician clinicians that can often either assist or directly provide primary care. Some studies have found that NPs can independently manage 80 percent of patients’ primary care needs. Other studies show that NPs provide high-quality care.
A recent article, however, suggests that NPs may not be cost effective. This is a curious result because NP salaries are much lower than primary care physicians (PCPs). Consider the following difference between the hourly wage for physician assistants compared to family and general physicians.
Drs. Liu and D’Aunno, however, argue that employing a nurse practitioner or physician assistance creates additional cost. First, the physician often needs to supervise the nurse practitioner. Physicians who spend time supervising NPs have less time to spend with patients. Second, some share of patients will have more complex conditions that only the physician will treat. These patients will have two office visits (first with the NP, then with the physician), but would only have needed one visit if they had seen the PCP initially. Third, if the NP is underutiliized, then the practice will be paying the NP for little work.
This is not to say that NPs are not cost-efficient. I believe that increasing the role of the NP can increase efficiency. The Lui and D’Aunno article, however, does note some of the conditions that are necessary for practices to leverage NPs effectively.
- Liu, N. and D’Aunno, T. (2012), The Productivity and Cost-Efficiency of Models for Involving Nurse Practitioners in Primary Care: A Perspective from Queueing Analysis. Health Services Research, 47: 594–613. doi: 10.1111/j.1475-6773.2011.01343.x
- Kreitzer, M. J., B. Kligler, and W. C. Meeker. 2009. “Health Professions Education andIntegrative Health Care.” Journal of Science and Healing 5 (4): 212–27.
- Laurant, M., M. Harmsen, H. Wollersheim, R. Grol, M. Faber, and B. Sibbald. 2009. “The Impact of Nonphysician Clinicians: Do They Improve the Quality and Cost-Effectiveness of Health Care Services?” Medical Care Research and Review 66(6): 36S–89S.