To the Editor.
—Unfortunately, Ginzberg1 completely omits the present role of midlevel health care providers, nurse practitioners and physician assistants, in his suggestions for solving the shortage of primary health care providers.An analysis of the impact these two midlevel professions already have on primary care today could be of great value in developing plans for increasing the numbers of primary care providers in the near future and significantly reducing the cost of health care as well.The only mention made by Ginzberg of either nurse practitioners or physician assistants is in the statement on page 3116: "It is not irrelevant to note, however, that the earnings of one physician are equivalent to those of three or four nurse practitioners." To which one could add, "or physician assistants."So, while there may be reasons to figure out how to persuade or subsidize more medical students to practice primary care,
Wexler D. Improving Access to Primary Care. JAMA. 1993;269(15):1944. doi:10.1001/jama.1993.03500150051025