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May 17, 2000

Health Outcomes Among Patients Treated by Nurse Practitioners or Physicians

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(19):2521-2524. doi:10.1001/jama.283.19.2521

To the Editor: The study by Dr Mundinger and colleagues1 compared the health outcomes of patients treated by nurse practitioners to those treated by physicians in primary care settings that were similar in terms of responsibilities and patient panels. There was no description of the training of either the physicians or the nurses in the study, other than that they were all faculty members. The authors state, "The combination of authority to prescribe drugs, direct reimbursement from most payers, and hospital admitting privileges creates a situation in which nurse practitioners and primary care physicians can have equivalent responsibilities." This combination does not include core elements of medical care such as evaluation, diagnosis, and treatment of undifferentiated patients. Patients with previously diagnosed and treated asthma, diabetes, and hypertension could be cared for successfully in a limited time frame by a person with less training than a physician. Each of these conditions has very clear treatment guidelines.

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