In Reply: Dr Perkins recognizes the impending crisis in primary care delivery in the United States and proposes that a solution to the low interest in primary care careers among current medical students is for physicians to relinquish the role to nurse practitioners and physician assistants. Although one study with brief follow-up found that the clinical outcomes of care by nurse practitioners were equivalent for certain conditions compared with the care provided by physicians,1 a Cochrane Collaboration review advised caution because most studies were methodologically flawed and of short duration.2 We believe that it is premature and risky to generalize these limited results to the typical populations internists serve, with their multiple, complex, and chronic medical problems.
Hauer KE, Durning SJ, Schwartz MD. Health Workforce Planning and Medical Student Career Choice—Reply. JAMA. 2009;301(8):824–826. doi:10.1001/jama.2009.159
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