The Right Care by the Right Clinician

Abstract

Increased demand for primary care has resulted in the increased use of advanced practice clinicians (nurse practitioners and physician assistants) to supplement the physician workforce. It is natural to ask how the care delivered by these advanced practice clinicians differs from the care provided by physicians. In this article, Hughes et al1 find that advanced practice clinicians order modestly more radiologic tests (0.3%) than primary care physicians among Medicare patients. However, this overall percentage difference obscures a more important finding. When the investigators focused on a common problem in primary care, lower back pain, they found that advanced practice clinicians ordered no more imaging tests than physicians, and when the investigators limited the sample to patients with acute respiratory illness, advance practice clinicians actually ordered fewer imaging tests. Advancedpracticeclinicianshavesubstantially feweryears of training than physicians, and it is not surprising that when confrontingunfamiliar conditions theymayordermore tests. At the same time, using advanced practice clinicians to care for patients with conditions for which they are familiar may produce the same or superior care, as theymay bemore willing to follow standardized protocols than physicians. In this regard, advanced practice clinicians may be better suited for practices that specialize in care of patients with a particular complex disease, such as patients with human immunodeficiencyvirus or hepatitis C virus, forwhich the issues aremore circumscribed than in general medicine settings where patientsmayhave awide andunpredictable range of symptoms and illnesses. It is all about putting the right clinician in the right position to provide the right care.