Pregnant and Scared: The Pros and Cons of Midlevel Practitioners in Emergency Rooms

Natasha Valle went to a Tennova Healthcare hospital in Clarksville, Tennessee, in January 2021 because she was bleeding. She didn’t know much about miscarriage, but this seemed like one. In the emergency room, she was examined then sent home, she said. She went back when her cramping became excruciating. Then home again. It ultimately took three trips to the ER on three consecutive days, generating three separate bills, before she saw a doctor who looked at her bloodwork and confirmed her fears. It’s unclear whether the repeat visits were due to delays in seeing a physician, but the experience worried her. And she’s still paying the bills.

This staffing strategy has permeated hospitals, and particularly emergency rooms, that seek to reduce their top expense: physician labor. While diagnosing and treating patients was once their domain, doctors 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 of the pay.

Critics of this strategy say the quest to save money results in treatment meted out by someone with far less training than a physician, leaving patients vulnerable to misdiagnoses, higher medical bills, and inadequate care. And these fears are bolstered by evidence that suggests dropping doctors from ERs may not be good for patients.

In this article, we will discuss the pros and cons of using midlevel practitioners, such as nurse practitioners and physician assistants, in emergency rooms. We will also provide an overview of the working paper published by the National Bureau of Economic Research and its findings.

Pros of Using Midlevel Practitioners in Emergency Rooms

Reduced Costs: One of the primary reasons for using midlevel practitioners is to save costs. In many cases, midlevel practitioners earn less than physicians, which can lead to substantial savings for hospitals. Since healthcare expenses are one of the highest expenses that many people face, it’s essential to look for ways to reduce costs while still providing high-quality care. Midlevel practitioners can help make this possible.

Increased Access to Care: Midlevel practitioners can be essential in increasing access to care, particularly in rural areas. According to the American Association of Nurse Practitioners, nurse practitioners are twice as likely to practice in rural areas as physicians. Midlevel practitioners can also help address the shortage of doctors that many areas of the country face.

Faster Service: Since midlevel practitioners can perform many of the same duties as physicians, they can help provide faster service. When emergency rooms are understaffed or overworked, midlevel practitioners can help fill the gap and ensure that patients receive timely care. This can be particularly important in emergency situations, where every second counts.

Cons of Using Midlevel Practitioners in Emergency Rooms

Lower Quality of Care: One of the biggest concerns about using midlevel practitioners in emergency rooms is that they may not have the same level of training and expertise as physicians. Physicians typically spend many years in medical school, residency, and fellowship programs, which provide them with a deep understanding of medical conditions and treatment options. In contrast, nurse practitioners and physician assistants typically complete less schooling and training, which could result in lower quality of care.

Increased Medical Errors: The risk of medical errors is another concern with using midlevel practitioners. Physicians have more training and experience, which can help reduce the likelihood of errors. In contrast, midlevel practitioners may have less experience and may not have the same level of knowledge about medical conditions and treatments, which could lead to more medical errors.

Less Ability to Diagnose Complex Cases: Another concern is that midlevel practitioners may not be able to diagnose complex cases as