Deprofessionalization in the health care setting doesn’t eliminate the
original profession; in this setting, the term is synonymous with de-
skilling. For example, the nursing profession has been
deprofessionalized to include advanced practical registered nurses
(APRNs), registered nurses (RNs), licensed practical nurses (LPNs),
registered medical assistants, certified medical assistants, medical
assistants, certified nursing assistants, and nursing assistants. The
original nursing profession is still in place and is in high demand but
has been de-skilled to account for health care workforce shortages
and to increase patient access to medical care. It’s become
increasingly common to observe complicated patients being treated
by APRNs and physician assistants (PAs). These providers are now
being allowed to perform procedures that historically required a
medical degree and residency training, while legislation is being
presented to grant non-physician practitioners the authority to
practice independently. At the end of the last decade, there were
more than 1 million physicians, 290,000 NPs, and 131,000 PAs in the
United States. In the last 10 years, the number of NPs has doubled,
and the number of PAs has grown 53.8%, while the number of
physicians has only increased 12%. If this trend continues, NPs and
PAs will outnumber physicians within the next 20 to 30 years.
Furthermore, other providers such as pharmacists, psychologists,
chiropractors, and optometrists are attempting to expand their role in
health care and take over some responsibilities of physicians (Balon
& Morreale, 2022). This doesn’t mitigate the need for physicians,
who have more education and training in subject matters than other
health care service providers may offer but is intended to increase
access to basic preventative health care services.
Although I don’t believe that deprofessionalization will lead to the
elimination of the physician profession, I do believe that it can result
in a decline in patient care for those who require more advanced
medical attention. Deprofessionalization in health care is more
economical for health care organizations, since paying an APRN is
more affordable than paying a physician. However, an APRN can’t
offer the same depth of medical expertise than a physician can. PAs
are required to complete 4 years of undergraduate education, 27
months of graduate school, and 2,000 clinical hours of training. NPs
complete a 4-year undergraduate degree or a 2-year Bachelor of
Science in Nursing program, a 1- to 2-year master’s or doctorate
degree, and 1,000 non-standardized hours of clinical training.
Physicians, on the other hand, complete 4 years of undergraduate
and 4 years of medical education, 3 to 7 years of residency training
(and potentially more with a subspecialty fellowship), and at least
15,000 hours of clinical training prior to independent practice (Balon
& Morreale, 2022). Rather than de-skilling the physician profession,
another option could be to make education and training required for
physicians more affordable and accessible, while making the salary
and benefits more competitive. Training more physicians to provide
high levels of subject matter expertise to patients who need it would
be a safer strategy than increasing the roles and responsibilities of
non-physicians to account for workforce shortages.
References:
Balon R. & Morreale, M. (2022). Demise of a physician. Annals of
Clinical Psychiatry.
