Nonphysician Clinicians

Are nurse practitioners cost effective?

Nurse practitioners (NPs) are non-physician clinicians that can often either assist or directly provide primary care. Some studies have found that NPs can independently manage 80 percent of patients’ primary care needs. Other studies show that NPs provide high-quality care.

A recent article, however, suggests that NPs may not be cost effective.  This is a curious result because NP salaries are much lower than primary care physicians (PCPs).  Consider the following difference between the hourly wage for  physician assistants compared to family and general physicians.

Drs. Liu and D’Aunno, however, argue that employing a nurse practitioner or physician assistance creates additional cost.  First, the physician often needs to supervise the nurse practitioner.  Physicians who spend time supervising NPs have less time to spend with patients.  Second, some share of patients will have more complex conditions that only the physician will treat.  These patients will have two office visits (first with the NP, then with the physician), but would only have needed one visit if they had seen the PCP initially.  Third, if the NP is underutiliized, then the practice will be paying the NP for little work.

This is not to say that NPs are not cost-efficient.  I believe that increasing the role of the NP can increase efficiency.  The Lui and D’Aunno article, however, does note some of the conditions that are necessary for practices to leverage NPs effectively.



  1. In primary care both NPs and PAs (who calls PAs “assistance” BTW can perform 95A% or more of the care needed by almost all patients.
    “Supervision” is needed by all, even other physicians.
    These are very few patients that need a second opinion that moment. If they do, most likely they are acutely ill and need a higher level of care (ER, hospital).
    This article is not up to date with current thinking or research.

  2. “NP salaries are much lower than primary care physicians (PCPs)”

    and income of PCPs is much lower than a surgeon.

    this is because level of expertise. higher the level greater payout.

  3. In the real world of primary care, Nurse Practitioners and Physician Assistants see the same patient complexity levels as the Doctor, need little supervision, patients only rarely need the so-called second visit referred to in the article, and yes PAs and NPs make about half to 2/3 the salary. Sounds productive to me. PA-C in Primary Care.

  4. Unfortunately, you chose to take the finding of a part of the study out of context. The findings actually supported that the more barriers there are to NP practice, the less cost effective the NP is, which makes perfect sense. If you have a highly educated highly skilled professional and do not utilize them to their full capacity what do you expect?? Your article should have focused on reducing barriers to NP practice to improve cost effectiveness and productivity.
    Dee Swanson NP

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