Physician Assistants and Nurse Practitioners go Head-to-Head with Doctors

Mafi and colleagues have used a large primary care database to compare use of guideline-discordant low-value health care services.[1] On multivariate analysis there is no winner – they use this service on an equivalent proportion of index conditions (e.g. use of x-ray in backache). Risk-adjustment and using the indication rather than the patient to create denominators reduces (but of course cannot eliminate) bias. Note, however, that making the same proportion of guideline-discordant services does not mean that care was of equivalent quality, since the services may be better targeted in one group than the other. The results support greater use of less expensive health personnel for the bulk of primary care, so that medical expertise can be better used.

— Richard Lilford, CLAHRC WM Director


  1. Mafi JN, Wee CC, Davis RB, Landon BE. Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians. Ann Intern Med. 2016; 165(4): 237-44.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s