A physician’s response: should registered nurse practitioners be reimbursed at the same rate as physicians?

On behalf of Physicians for Patient Protection, a grassroots group of over 12,000 practicing physicians and medical students, we would like to clarify several points regarding the healthcare policy proposal discussed in the article, “Should Registered Nurse Practitioners be reimbursed at the same rate as physicians?: Senate Health and Long Term Care committee hears testimony on SB 5222.”

 

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While advocates of SB 5222 argue that nurse practitioners can provide the “same” care as physicians, research comparing the two professions is sparse. In fact, the largest and best analysis from 2018 found only 18 high-quality studies over the last 50 years. Just three of these eighteen studies were performed in the United States—and none involving nurse practitioners practicing without physician supervision.

Although there is little data to support the safety and efficacy of nurse practitioners treating patients without physician involvement, studies do show that nurse practitioners utilize more health resources than physicians, including ordering more laboratory and diagnostic tests than physicians, performing more inappropriate skin biopsies than physicians, and placing more inappropriate referrals than physicians. Nurse practitioners also prescribe more medications than physicians, including inappropriate antibiotics, steroids, opioids, and psychotropic medications. This additional use of healthcare resources is likely to contribute to an increase in healthcare spending for insurers and patients.

Physicians are required to complete a minimum of 15,000 hours before they are permitted to treat patients independently, while the minimum number of clinical hours to graduate as a nurse practitioner is just 500. Paying more for a professional with a higher level of knowledge and training can hardly be viewed as discriminatory. In addition to lower training requirements, nurse practitioners often carry low malpractice insurance coverage. If a patient is harmed by a nurse practitioner, they will have little recourse to be compensated for this malpractice, despite paying the same amount as seeing a highly-trained—and insured—physician.  Another potential unintended consequence of this bill: with an increase of private equity in healthcare, corporations will be incentivized to replace physicians with nurse practitioners, thereby worsening healthcare access inequality in the state by restricting patient access to physicians.

Our Washington-state physician members also question this double standard: if nurse practitioners and physicians should be paid ‘equally’ for their work, why must physicians pay nearly $1,000 for a 2-year license to practice medicine in the state, while nurse practitioners pay just $125 per year?  With the cost of additional years of education, higher licensing fees, board certification fees, and continuing education, physicians pay far more than nurse practitioners for the right to practice medicine.

Finally, the implication by supporters of SB 5222 that paying nurse practitioners less than physicians is a gender equality issue is demonstrably false. Women now comprise fifty percent of all medical school graduates and men are increasingly entering into nurse practice. In fact, seven out of the nine board members of our organization are women physicians.

Niran Al-Agba MD is a pediatrician in private practice in Silverdale, WA, and a member of Physicians for Patient Protection. Rebekah Bernard MD is a family physician in private practice in Fort Myers, FL, and the president of Physicians for Patient Protection.  Al-Agba and Bernard co-authored the book, “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare” (Universal Publishers 2020).