Can NPs and PAs Replace Hospitalists?

Alok S. Patel, MD


September 20, 2018

I might open a floodgate with this topic, but that's the point.

I'm hearing about a national debate on whether nurse practitioners (NPs) and physician assistants (PAs) can replace hospitalists. I've even heard of consulting firms actually doing this to save overhead costs.

Give me a break. I think this belittles all three of us. Hospitalists go to med school and residency—some go on to fellowship. We work best when we integrate with NPs and PAs, not when we replace each other.

The PAs in my hospital are rock stars. The ones I work with tend to be specialized in cardiology or surgery. They are great at what they do.

The NPs I work with are also solid. They are knowledgeable; their nursing background gives them awesome bedside skills, and they are a vital part of any hospital team.

PAs usually have to work under a supervising physician but they have a lot of autonomy. NPs can work independently in 22 US states and Washington, DC; this is a huge part of filling the physician shortage in underserved areas.[1,2] That is a primary care win.

But in the hospital or even in some large practices, NPs, PAs, and doctors have different roles.[3,4,5] We shouldn't let the Internet or some consulting firm disregard our unique skillsets.

It's all about integration, not replacement. This is obviously a deeper topic than what I can do in 90 seconds, so you guys take it away.

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