Quality of Care: Physicians Versus Non-Physicians

A big, if not the biggest, component of America’s health spending issues is unit price, which is substantially higher for health care services and products than in other countries.  One way to help control health spending is to use the lowest unit-cost provider.  For example, nurse practitioners and physician assistants could substitute for physicians.  While some physicians have embraced the use of these classes of providers, others have supported practice limitations in many states that inhibit maximal use of these lower-cost options.  One rationale is that they cannot deliver the same quality of care as physicians do.  Prior research has suggested that this not true and a new study focussed on routine care for cardiovascular disease patients finds that care from non-physicians can be equal or even better than that provided by physicians, according to common quality measures.  (Non-MD Study)  The study was conducted in 130 Veterans Affairs centers for cardiovascular visits between October 2013 and September 2014.  They compared visits with physicians and with non-physicians on three measures:  blood pressure level, receiving a statin, and receiving a beta-blocker.  Patients seeing a non-physician were slightly more likely to have good blood pressure control, while patients being treated by a physician were slightly more likely to have good cholesterol levels and to receive a beta blocker.  Overall quality by these measures was equivalent, although not great since only 54% of those patients treated by physicians and 54.8% of those seen by non-physicians met all three quality standards.

So one lesson from the study is that there is not a significant quality risk in receiving care from non-physicians.  Another, which you should keep in mind next time you read one of Atul Gawande’s articles, is that while there may be a lot of inappropriate care in America, there is also a lot of care that should be received that isn’t.  I strongly suspect that the two roughly balance out and that if all patients got the care they should get, our spending would be no lower than it is today.