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Editor's Note
January 2015

The Right Care by the Right Clinician

JAMA Intern Med. 2015;175(1):108. doi:10.1001/jamainternmed.2014.6441

Increased demand for primary care has resulted in the increased use of advanced practice clinicians (nurse practitioners and physician assistants) to supplement the physician workforce. It is natural to ask how the care delivered by these advanced practice clinicians differs from the care provided by physicians.

In this article, Hughes et al1 find that advanced practice clinicians order modestly more radiologic tests (0.3%) than primary care physicians among Medicare patients. However, this overall percentage difference obscures a more important finding. When the investigators focused on a common problem in primary care, lower back pain, they found that advanced practice clinicians ordered no more imaging tests than physicians, and when the investigators limited the sample to patients with acute respiratory illness, advance practice clinicians actually ordered fewer imaging tests.

Advanced practice clinicians have substantially fewer years of training than physicians, and it is not surprising that when confronting unfamiliar conditions they may order more tests. At the same time, using advanced practice clinicians to care for patients with conditions for which they are familiar may produce the same or superior care, as they may be more willing to follow standardized protocols than physicians. In this regard, advanced practice clinicians may be better suited for practices that specialize in care of patients with a particular complex disease, such as patients with human immunodeficiency virus or hepatitis C virus, for which the issues are more circumscribed than in general medicine settings where patients may have a wide and unpredictable range of symptoms and illnesses. It is all about putting the right clinician in the right position to provide the right care.

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Conflict of Interest Disclosures: None reported.

References
1.
Hughes  DR, Jiang  M, Duszak  R  Jr.  A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits [published online November 24, 2014].  JAMA Intern Med. doi:10.1001/jamainternmed.2014.6349.
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