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August 24, 1994

Nurse Practitioner Redux Revisited

Author Affiliations

Seattle-King County Department of Public Health University of Washington Seattle

JAMA. 1994;272(8):592. doi:10.1001/jama.1994.03520080033033

To the Editor.  —We read the article by Dr DeAngelis1 with interest. We agree that the coming of health system reform offers an opportunity to examine and perhaps redefine the roles of NPs in providing primary care. However, we would broaden the effort to include physician assistants (PAs). All the issues DeAngelis raises about NPs also apply to PAs.Over the past two decades, an unfortunate sense of competition has developed between NPs and PAs, with disagreement about which group is more qualified to provide mid-level care in various settings. Our experience over 15 years of working closely with both groups is that there is no difference between them in the quality of care they provide or the clinical judgment they exercise. (Of course, there are differences between individual clinicians, but this does not seem to correlate with the type of training.) More than a decade ago, the University

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