Pretty much what I've seen. We use ANP's and PA's (grouped together as APP's, Advanced Practice Providers) in every ER I work in these days, and we couldn't get by without 'em. Their scope of practice is limited, and rightly so, but as Kevin pointed out previously, a specialty APP will know more about that specialty field than most MD's who aren't in that field, so their value to you as a patient can be really high.
I have steered a couple of young people away from medical school in recent years, advising them to get their bachelor's degree in nursing, then get an advanced degree as a nurse-anesthetist or ANP as a more cost-effective alternative. Most young docs I talk to these days graduate with more than $300K in student loan debt, which will take decades to pay off at current pay rates. Doctor salaries aren't what they used to be (compared to other professions) as corporate medicine becomes the norm and MBA's make most of the decisions.
I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
I am a Neonatal Nurse Practitioner (now retired). I wholeheartedly agree with you Doc, especially the red highlighted parts. Back about '95 I looked into going to med school to up grade from NNP to MD. I found that the average MD/DO graduated with about $250k debt. The average cost of starting a new solo practice was about $250k not to mention maintaining staff, equipment, liability insurance, etc. I checked around with local physicians and found that the typical salary in my area for a Pediatrician joining a large practice was $90k with a top of about $120k, the solo guys were topping at about $160k (+ headache of running your own business and 24/7/365 on call). I was making $80k and had a good pension plan in place (PERA). One physician explained to me to not discount that pension in my plans. I figured out that to pay off the debt I would not only be effectively working for far less than I was currently making but would not be contributing toward retirement as well as my current pension plan. Did I mention wife and two kids?
I also agree about the admin part, it mirrors what has happened in colleges/universities. Big government infusion of cash (loans) and admin balloons massively yet teacher salaries have not kept the same pace as the increase in tuition.
