APCs and Testing

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This is the conclusion from a JAMA study in January:

Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. Expanding the use of APCs may alleviate PCP shortages. While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level.

I am aware that the same people will send me hate mail claiming that this study is somehow irrelevant.   I am only being fair.  We get studies thrown at us all the time from the powers that be or from the NPs/PAs that claim that they can do the same job as family docs.  They cannot and here is another study proving it.  This is why education and training matter.  Interestingly, that is why NPs/PAs are paid more than nurses. There is a difference.  In fact, I highly recommend you look at something called the Dunning-Kruger effect.  In essence it says that:

The most competent individuals tend to underestimate their relative ability a little, but for most people (the bottom 75%) they increasingly overestimate their ability, and everyone thinks they are above average. There are several possible causes of the effect. One is simple ego – no one wants to think of themselves as below average, so they inflate their self-assessment. People also have an easier time recognizing ignorance in others than in themselves, and this will create the illusion that they are above average, even when they are in the single digits of percentile.

Dunning said that, “Incompetent people do not recognize—scratch that, cannot recognize—just how incompetent they are.  What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.”

This is NOT to say that NPs or PAs are incompetent or not needed.  It says that the less we know the more we can sometimes fake it to make it which is VERY dangerous in the field of healthcare.  When a PA on a recent blog here stated he did gold standard care I was shocked and aghast. What the hell is gold standard care?  I am a good doc because I still know how little I know.  A fellow resident I worked with during my residency was a former PA.  He often said that once he became a doctor he was amazed at how little he actually knew when he was a PA.   This is not a knock against PAs or NPs.  This is just a pat on the back for higher education.

Now, let the hate mail begin. Keep it civil and cordial and respectful.  If it is too aggressive then I will not let it be published.  Been there.  Done that.

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