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Comment by heymijo | Hacker News Reader

I just realized Physician Assistants (PAs) and Nurse Practitioners (NPs) have been forgotten in this equation.

126,000 practicing PAs [0]

325,000 licensed NPs [1]

985,000 practicing physicians (MDs and DOs) [2]

I know that nurse practitioners are not under the same artificial residency constraints of MDs/DOs. I'm not sure about physician assistants.

For someone not in the U.S., NPs and PAs often do the same role as general practitioners/family doctors e.g. see patients, prescribe medicine, etc. They can also specialize.

[0] https://www.thepalife.com/physician-assistant-stats/

[1] https://www.aanp.org/about/all-about-nps/np-fact-sheet

[2] https://en.wikipedia.org/wiki/Physicians_in_the_United_State...

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PA/NA education is a complete joke compared to what your average MD gets.

They are not qualified to practice as general doctors at all.

However, they are really cheap, which is why corporations are pushing them so hard. Substandard care in the name of profits.

Wow I was about to gush about how much I LOVE my NP compared to my old crappy, braindead MDs. I could share stories of how bad MDs are...and the horrors of insurance.

She is sharp as a whip. Smarter and more motivated than ANY MD I've EVER had. Anything she doesn't know about, she researches (on her own time/dime). She prescribes everything - dirt cheap. Lets me text/call/email ANY time. Refers me to a specialist for anything beyond her expertise (just like any MD would!) DIRT CHEAP (eg: MRI for $300, scheduled within a day or two down the street). A single, cheap, monthly fee ($65/mo!) lets me see her any time day and night, ask anything, discuss as long as I like...and I do all these things! No MD going through standard insurance would allow anything even remotely similar.

...I could go on...

imo the NP model is FAR superior than the traditional insurance+MD crap model we have right now. It's one of those things "they" don't want people learning about since it'll crush the traditional way of doing things once people realize how amazing that model is.

Yes I have basic insurance since it's required. And, just in case - she obviously doesn't have an emergency room.

Your access to care is the result of the direct primary care model not your NP necessarily. Your NP might be good, but I'm willing to bet on average the people who have a minimum of 15,000 hours of clinical training (MDs/DOs) before independent practice are more competent than the ones who only are required to get 500.

More motivated? Why wasn't she more motivated to go to school for four years, get in-depth training in residency, and become an expert in her field rather than taking the easy "route" to practice "medicine"? I guarantee the IM docs and surgeons slugging it for 80+hour work weeks in residency to become experts are more dedicated and motivated to care for patients than the NPs who train part-time and online.

If only we could have stopped doctor salary inflation instead, like other developed countries :)

Cheaper salary and they order more unnecessary tests, imaging, and consults, which, what do you know, the hospital system also makes money off of. It's a win-win for the hospital, but patients and the healthcare system lose.

> They are not qualified to practice as general doctors at all.

The way we train MDs is... highly counter-productive to say the least. First a completely unrelated undergrad, which really adds no value (hint: Foreign doctors can do a fellowship and get licensed to practice in the US without having an unrelated undergrad degree pre med-school). Then med school, which is completely detached from any clinical experience. Then residency, where practical knowledge is theoretically built but in practice is more of a legally sanctioned hazing (patient outcome doesn't really matter, what matters the most is impressing whoever is slightly higher on the pecking order in order to get the spot you want).

Multiple years of zero sum games and competition against your peers. Then, once you get your license, you are supposed to make a complete 180 and start becoming a team player.

To be completely honest, if you add up the useful time spent in school, an MD is just about on the same footing as a PA/NA.

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