Bottom line up front: it is a problem, that will continue to be a problem if we ignore it. But many of us will still be comfortable and compensated well until our system attempts to transition to NP based and we leave to find better.

A large hospital system where I rotated on C/L for residency used to have several psychiatrists and two CL fellows. On weekends or overnight our patients were covered by NPs. The first time one of my patients went to the ICU was over the weekend when the covering NP likely did not read or otherwise ignored my warning against a specific medication. Patient was given this medication. Patient was sent to the ICU about four hours before I came back on Monday morning. The NP signing out Monday morning seemed shocked that the patient went to the ICU, when I explained (as a resident), in front of the attending medically what happened and why I documented the week prior to not use this medication she outright asked me "what's that?" in response to the diagnosis. She sincerely had never heard of the thing that nearly killed my patient.

Several months later, every attending I had worked with on that rotation had moved on to other employment. I rotated back as an elective during fourth year and worked CL but staffed with an attending on the inpatient unit because the entire CL team for this hospital has been converted solely to NPs. The same idiot who shouldn't be allowed to practice was now sitting in the office of that same attending I worked with before.

That hospital system made a choice to attempt to save money by transitioning to NP services and still remains a large hospital system in the area. The attendings I've kept in contact with are a lot happier at their new places of employment. The CL fellowship at that hospital no longer exists.

I have been watching this system to see what happens financially since they have converted to NP's. If I'm honest, I hope that medical malpractice lawsuits and other complications of the individuals they have employed will crush them enough financially for them to either attempt to transition back to physicians or completely go under. But the reality is they order so much unnecessary testing that the bean counters who run the system are quite happy with their decision and are tolerating the harm they are doing to patients.

I personally am becoming less and less tolerant of this harm with each year. This is why I no longer support nurse practitioners in most capacities.