Does the Use of APPs Turn Back the Clock?

From Emergency Physicians Monthly – Opinion (hat tip: Dr. Menadue):

Now the era of the ever-expanding physician extender has emerged in emergency medicine. Why are physician extenders needed? I doubt that anyone assumes physician extenders are better providers than emergency physicians; rather, they are cheaper and, since there are not enough emergency physicians to go around, we must need them. A similar argument was advanced in Missouri when it proposed assistant physician status to medical school graduates who did not match into residencies. They could practice in rural areas after one month with another physician monitoring them. Is it better to have an inadequately trained caretaker or none at all. This is a recurring question in medicine. Every graduate of medical school knows that four years is not enough training to practice medicine. More training to build on the 4-year knowledge base is required. The “emergency room” physicians of the 1950s and 1960s who so appalled the public had four years of medical education before they even had any opportunity to do clinical work. Then, they had additional and varying degrees of patient care training. Despite this training, they were deemed unqualified. Are extenders better trained than those physicians? In fact, are extenders necessary or are they expedient? Extenders are not hired because they provide better care than the physicians they replace. Better care is not what drives their use. They are cheaper to hire than physicians and create a fatter bottom line.

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