Are Doctors Overrated?

One of the obstacles often cited in reining in US medical costs is that doctor salaries would have to fall, and therefore good people would no longer come into the profession (they’d either launch a hedge fund or go into the unregulated, better paid part of the business, like plastic surgery).

But that assumes that doctors have to be the main service providers, or patient health will suffer. But that assumption is false. A post in Overcoming Bias (which we found via The Stalwart) tells us:

Primary care doctors eat a big chunk of our medical budget (median salary 155K$), yet (confirming previous findings) a randomized trial published in JAMA in 2000 found docs no better than nurse practitioners (median salary 77K$):

1316 patients who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510). … No significant differences were found in patients’ health status … at 6 months … hypertension … was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg; P = .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (P = .88 for overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; P = .05).

But docs are taught more medicine than nurses; why are they no better at primary care? Probably because docs are famously overconfident. For example, one study found that on average when docs were 88% confident that their patient had pneumonia, in fact only 20% of such patients had pneumonia. And overconfidence is fatal in primary care.

Another testament to nurse competence: emergency room triage is done by nurses. And conversely, another sign of the dangers of the God syndrome among doctors: residents seldom question senior physicians, even when it seems apparent that they have made a mistake, because their observations are not welcome.

The diagnostic abilities of doctors, or any front line medical professional, are limited. Of the roughly 8,000 recognized ailments, only about 2,000 are common, so if you happen to suffer from one of the obscure 6,000, it is almost certain that a primary physician won’t make a correct diagnosis. It will take considerable trial and error (and likely visits to many specialists) before you (hopefully) get a correct diagnosis. Again, no harm will be done, and considerable costs will be saved if the intial screen was performed by a nurse who can eliminate certain possibilities and order tests for the most likely diseases.