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Low, although I'll note that my exposure to the field is much more extensive than you're thinking (although I'm not inclined to provide details). I'd definitely be interested in the data you're referring to - do you have any summaries I can take a look at?
If you meant for educational quality:
We've already introduced "lower education" doctors in the U.S. for awhile now, they are called PAs and NPs. It's been researched. Tellingly, their best case (presented by the nursing lobby) is research that shows that NPs results in equal outcome with U.S. MDs without controlling for case complexity (basically the doctors got the complicated cases, the NPs get the easy cases, and they still ended up with similar outcomes).
More research has shown pretty wide outcome disparity and things like a dramatic increase in costs from the NPs (due to unneeded referrals and excess testing, the later of which is often a direct harm to the patient).
Here's an example link: https://www.ama-assn.org/practice-management/scope-practice/3-year-study-nps-ed-worse-outcomes-higher-costs?utm_campaign=Advocacy
If you meant for the bottle neck:
I'm asking you, as I generally find that posters with an opinion on this don't actually know where the bottleneck is.
It's worth noticing that this source is from the AMA, which is an American physicians' group that lobbies to protect American physicians' class interests, including preventing mid-level health care professionals (NPs, PAs, etc.) from encroaching on practice areas seen as reserved for physicans. The url itself identifies this article as part of an advocacy campaign. The article highlights:
That doesn't necessarily make anything it says wrong, of course. But I'd expect the article published by the corresponding NPs' association to emphasize different observations and to reach different conclusions.
It's fair to say that obviously the AMA has an agenda, but it's also pretty objective that midlevels don't save any money (and in some cases cost more), it's just also popular with hospitals because they have a tendency to cost more in ways that benefit the hospital (like unneeded testing) instead of professional fees.
It's also pretty objective to say that NPs have 500 hours of training and doctors have 10k-20k. That gap is enormous and even if each hour of training is mostly worthless....it's a lot.
It's also true that NPs after graduating from a program can practice in whatever specialty they want with no specific specialty training, and changes fields with no training. Doctors require 3-10 years of extra training and retraining if they switch fields. Those years are generally 60 hour weeks minimum if not closer to 80 or beyond.
Even if you hate doctors that's a lllootttt of extra education.
This seems to refer to clinical hours. Per wikipedia: During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training in addition to the clinical hours required to obtain their RN. Let's leave aside the RN component. If clinical hours are the focus, then a typical NP who's been practicing professionally for 10 years has more than a physician who's been practicing professionally for 5 years.
This conversation brings to mind Yud's Is That Your True Rejection. Doctors are better than NPs, they have more clinical experience. No? Well then doctors are better, they have better outcomes. No? Well then doctors are better, they cost the system less money. No? Well then, doctors are better, their training is more rigorous. No? Well then, doctors must be better for some other reason.
The NP model was designed around the idea that experienced nurses working with significant clinical background would go back to school to get some "finishing." This is not the case anymore, it's extremely common for nurses to go for NP immediately because bedside nursing sucks and the pay is higher for NPs. Online only programs also exist now. I've seen an NP student exactly once in my entire career, she was shadowing in a family practice office doing nothing while the med students saw patients (she wanted to be an NP so she could be a medical director at a spa).
Claws out? NPs absolutely fucking suck and I see outright malpractice on a regular basis. And you can't even sue them for their idiocy.
Physician vs. Nursing training isn't apples to oranges, it's apples to wrenches. Physicians spend years being abused and called idiots in order to develop caution, intellectual humility, and limitation awareness, only when mastery has finally started to arrive does the confidence get papered over that fear. The nursing model is centered around establishing early excess confidence (so you can speak up if you feel the doctor is off base) and the what, never the why. And nursing tasks, which are incredibly important but learning how to make an IV tower stop beeping has precisely zero to do with with "this patient isn't having a neurological emergency you just got Albuterol in their eye."
If I had a dollar for every time I saw an NP managing someone in the ICU nearly kill a patient because they did the thing they always did (not realizing that with the specific patients comorbidity it'd be fatal) I'd fucking retire.
Urgent Care and Emergency Medicine (well, with the way most patients use this service) are extremely algorithmic and that gives people (both patients and yes also nurses and other healthcare workers) a false confidence in the simplicity in the provision of medical care but shit is fucking complicated and nursing training doesn't teach you jack shit, no matter how much of it you have. 30 years working in construction doing labor is nothing like going to architecture school.
A good NP can operate on the level of an Intern (first year resident) a great one can operate at the level of a second year resident. I've never, ever seen an NP operate at the level of a more senior resident or attending.
And oh god psychiatric NPs. Again if I had a dollar for every time I saw a patient managed by a psych NP who was on Benzos for their anxiety caused by excess Adderall I'd retire.
Nurses have better PR and everyone likes to hate on the doctor because we don't have time to talk to the patients, make a bunch of money (not really true anymore) and COVID etc. but the midlevel lobby is an absolute racket that is accelerating the death of the system through an excess of unnecessary consults, poor patient management, and a lack of easier breather cases for physicians.
Every physician I know who doesn't have a financial stake in midlevels (and isn't in admin) tells their friends and family to only see doctors whenever possible. That's for a reason.
In India, the few private hospitals that do hire NPs use them for one purpose only, they're usually trained to do procedures in the ICU, I'd say usually under doctor supervision, but I was a Medical Officer fresh out from an internship and my presence was superfluous. At least they never dared to take training opportunities away from actual CCM residents or registrars, if they wanted to do something, they got a crack at it.
If you think the US is bad about mid-level scope creep, wait till you hear about the UK.
There, NPs and PAs are both just about as useless as there, but have been bulldozed in by the government because they're far cheaper in the long run than an actual doctor, you know, the kind that expects career progression and also has the temerity to run away for greener pastures when fucked with.
They can't prescribe, nor order most investigations, and anything they do has to be be double checked by a harried doctor. Thankfully, the movement to curtail their expansion has been taking off hard, with doctors both working to rule (Oh, as a PA you report only to my consultant? Sorry, I'm snowed in, I can't sign off on a patient I haven't personally reviewed, please go badger the boss, they'll be very happy about it).
In fact, new guidance on the level of autonomy they possess, especially in GP, makes it so that they're effectively redundant in any practice, so the latter are now begrudgingly forced to accept that actual GPs are non-negotiable.
Add in scandals over them grossly overstepping their remit, and fucking up cases that would be obvious to any semi-competent doctor, such as dismissing obvious MIs with good old PPIs and a paracetamol..
It's all exacerbated by rotational training, with consultants unwilling to invest effort in mentoring and training their juniors who are going to fuck off to a new hospital, whereas they could at least teach the rote mechanical skills to a NP/PA who'll be working under them for their whole career.
What's doubly farcical is that they're paid more than FY1 and FY2 doctors, who are both more competent, and in the latter case, actually capable of ordering followup investigations for whatever they suspect is the case.
This bit is one of the worst bits. So they get paid more than residents. Work literally half as much. Hoover up all the easy cases. Fuck them up anyway. And work strict hours with breaks so they don't get a lot of work done anyway and just leave midway through shit.
On some inpatient units adding an expensive mid level who costs as much as two residents actually makes things worse. It's insane.
I also just do not understand why it's so hard to convince people that doctors with tens of thousands of hours more training are in fact more competent than nurses with a small amount of shadowing experience and with little to no formal education in actual medicine.
Clown world.
They bear almost no medicolegal responsibility, as long as they do their job, which is being largely useless. Seriously, if you, as a random doctor on the ward, ever get called over while harried to death in the middle of your shift and they ask you to sign off on their suggestions, then it's all on your head if something goes south. And if you refuse, well, you better be ready to face the ire of your seniors, who'll tell you to be a team player.
Fucking, hell they make more money than I do for my first year as a CT1 trainee. Matching my salary next year to boot. Maybe a quarter the time in education, exams where it's ridiculously difficult to flunk, and then they rake in the big bucks and have stable postings without rotational training and can coast until they often end up poached into managerial positions that were once expected to be done by doctors.
It might be a clown world where you're at, but here, the inmates are running the asylum. The UK has a massive shortfall of actual training positions, so it's both a miracle I made it on my first go, and people who don't are SOL till next year around while yet more medical students are pumped out. (I note the conflict of interest as an IMG, but I don't care, they have it easy compared to the shit I go through, and if they want to protest the erosion of pay and scope creep, I'm with them in the picket line)
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