Last week a woman sustained a minor head injury and went to an urgent care. The nurse practitioner looked her over and told her she should go to the hospital emergency department. She followed that advice. After waiting several hours – because it was Monday, and emergency departments are often crazy busy on Mondays, which means long waits for those who are not critically ill or injured – she saw a doctor. The doctor took a history and did a proper neurologic examination. Drawing on a deeper understanding of head injuries and a thorough familiarity with what the scientific literature tells us about the proper way to evaluate patients with head injuries, the doctor told the patient she did not need a CAT scan of the head – which was the main reason she had been sent to the ED.

So now the patient has a visit to an urgent care, to which has been added a visit to an ED, where she had to wait a long time, and for which she will get a second bill, higher than the first one. How’s the value proposition now?

About now you may be thinking,

couldn’t we just teach the nurse practitioner how to do a better job evaluating the patient with a minor head injury? Sure we could. We could teach the nurse practitioner how to do a better job at just about anything. That would take some time, though. And the reason doctors are more expensive than nurse practitioners is that it takes longer to train someone to that level. You see where I’m going with this.

To the best of my knowledge, there are very limited data on outcomes in primary care – and no long-term outcomes data – comparing physicians with NPs. Such an absence of data leaves me free to answer the question based entirely on my opinions – which, as you know, are invariably carefully considered, unassailable in their logic, brilliant in their exposition, and wise beyond compare. Oh, and they are always correct. (Now extracting tongue from cheek, not without considerable difficulty.)

My internist is a fellow who was several years ahead of me in training. When I go to see him, I know he will follow all guidelines-based recommendations for primary and secondary prevention of chronic diseases. I know a primary care nurse practitioner would do the same thing. I admit to preferring the physician over the nurse, because if I have questions about the science underlying the recommendations, I know which one is more likely to be able to answer them to my satisfaction.