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Comment by wyldfire | Hacker News Reader

> While diagnosing and treating patients was once doctors' domain, they are increasingly being replaced by nurse practitioners and physician assistants, collectively known as "midlevel practitioners," who can perform many of the same duties and generate much of the same revenue for less than half the pay.

IMO, PAs and NPs are a good idea for medicine overall. Especially since lots of folks who would consider a career in medicine are turned off by residency.

In the ER, though -- I can see the case for experienced MDs making a big difference in outcomes.

Disclosure: my wife is a PA.

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I strong disagree. From the hospital perspective, NPs and PAs are cannon fodder thrown on the line.

My sister in law is a NP who quit the ER. She worked as an RN in an ER for a decade and knew that she lacked the training and skills to be doing some of the stuff she was forced to do.

Patient lives and her license were at risk every day.

Counterpoint: You can go read the “Noctor” subreddit or ask any practicing physician why it’s bad for patient outcome.

Ultimately we need more doctors and less hospital administrators.

Man, that subreddit reads like the most massive case of sour grapes imaginable.

It's just people (presumably a lot of physicians / med students?) griping about how NPs and PAs are acting too good for their titles. All the actual stories are, like, one-off anecdotes about how some NP made some medical mistake. As if MDs don't make a massive amount of mistakes, I guess?

Edit: lol, reading more, and I have seen multiple posters and commenters directly reference how much less "intelligent" NPs and PAs are. This whooooole sub is just a massive superiority complex

Edit2: There's a moderator bot that automatically responds with a list of rebuttals, which includes this beauty:

> You're just sexist. Ad hominem noted.

They covered that one already:

https://www.reddit.com/r/Noctor/comments/yf3ajr/updated_fpa_...

> Arguments Not Allowed

...

> Doctors make mistakes too. Yes, they do. Why should someone with less training be allowed to practice independently? Discussions on quality of mistake comparisons will be allowed.

If we need more doctors then it's time for doctors to rectify that themselves. Doctors and dentists both gatekeep their professions because of money, not because of talent.

I know plenty of "practicing physicians" that speak highly of midlevels. Comparing tenured doctors to the student-filled shit factory that is "noctor" is either extremely disingenuous or extremely ignorant.

> You can go read the “Noctor” subreddit

There's just no way I would take medical advice (like which provider to choose from) from a site that's basically anonymous creative writing.

And let's be frank: just browsing this subreddit, it reeks of sexism and racism (it's no coincidence that the demographics for nurses are different than doctors). There's also not a single verifiable claim or study that would prove their point. And a lot of comments about IQ that sounds eerily similar to the current discourse of "race realists"...

> Ultimately we need more doctors and less hospital administrators.

I guess I tend to agree but you can't just conjure them up. You can set policies to encourage physicians to emigrate to the US and make it easier for students to pay for med school, but in the end only so many people are going to want to become doctors.

Doctors say we need more of them and their high pay?

I'm sure the high paid software engineers at boeing said something similar when jobs were being outsourced "we need more US engineers". Look at the software problems they had and tell me they were wrong.

Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.

> Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.

It was rather trivial for Boeing engineers to show, without a doubt, that the cheap offshored programmers didn't write software as good as they did. The design simply spoke for itself and didn't perform to spec.

Why not simply have doctors do the same? If their fellow medical workers can't deliver the same quality of care at the same speed and cost, then it should be trivial to show.

With the Boeing engineers the outsourcing wasn't obviously an issue to individuals outside the system until the 737 MAX was grounded and 346 people were dead. Requiring such a sentinel event before the value of US engineering was known to the public suggests to me that it was not trivial for the Boeing engineers to prove their value.

Doctors are at a greater disadvantage as there is not likely to be a sentinel event that kills 189 people at once. Nothing about the US medical system is trivial.

Consider the private equity run emergency department in the article, I am sure that they could make more profit off of NPs and that doctors wouldn't save private equity costs. The article suggests that NPs are saving private equity money while costing patients and taxpayers more. Speaking of quality, why should private equity care about quality if it doesn't effect their bottom line?

That's correct but I believe their bias makes them a untrustworthy worthy source

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