Letter to the Editor: ‘We need more physicians,’ not more APPs to plug the workforce gap
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By Nirmala M. Sivaprakasapillai, MD
Although I appreciate the insights from Edward V. Loftus Jr., MD in his editorial regarding the GI physician shortage, as well as the accompanying cover story, I feel compelled to comment on some of the points within the article.
The shortage of GI physicians has been predicted for years and maybe we are seeing this prediction coming to fruition earlier than initially expected. There continues to be stringent criteria to enter medical school, yet nurse practitioners can be certified after 2 years of online learning. Why not push to increase the matriculation number to medical schools and decrease the number of years in medical school to 3 years? Why not decrease the time spent with basic science and increase hands-on experience? Why not increase the number of residency positions and fellowship positions?
In 2022, more than 2,000 residency positions went unfilled. There are thousands of foreign medical graduates who are qualified, yet the United States Medical Licensing Examination I — which is not an indication of the quality of the physician — hinders them from advancing. Why not utilize physicians rather than paving the way for 2-year online degrees that produce poorly trained nurse practitioners who, in turn, deplete the already dwindling community of nurses? Instead of more advanced practice providers (APPs), we need more physicians.
In the world of corporate medicine, APPs are utilized as much as they are because the reimbursement is 80% to 100%, and these practitioners are paid less than a physician in the same field. We are one of the few countries who utilize APPs, yet do not have better outcomes to show for it. In recent years, we have found that APPs tend to order far more imaging tests without the same clinical judgement.
Physicians, nurse practitioners and physician assistants are all clumped together as “providers” when it suits the powers that be and to confuse patients so they feel like they are receiving equal care. Unfortunately, as physicians, we have allowed medical care to become dictated by corporations and insurance companies. As physicians, we need to put emphasis on the importance of providing the best care for patients, and I believe that is by increasing the physician workforce, increasing matriculation to medical school and increasing residency and fellowship positions. If this occurs, I predict many providers will pursue a career as a physician rather than as an APP.
Nirmala M. Sivaprakasapillai, MD, is a gastroenterologist in Largo, Florida.
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