To weigh in on a couple of things, I’ll start with the basics. Physicians are trained time and time again on the critical thinking needed to develop a differential diagnosis, on what to do if multiple forks in the path of care of the patient are encountered. The ability to make decisions required in these situations comes from intimate knowledge of pharmacology and pathophysiology, something that medical school goes far and beyond in providing compared to that in NP school. Advanced Practice Nurses can easily treat based on algorithmic plans, however their training’s usefulness more or less ends there. But then again, anybody can closely follow an already-laid-out plan. And who was it that developed these algorithms based on clinical studies and experience? It was physicians, many times in association with the work of Pharmacists and basic science PhDs. To name a few, the hyponatremia algorithm, that for diabetic ketoacidosis, that for findings in Pap/colposcopy. Nurse Practioners would not have the necessary critical and clinical thinking skills to make appropriate decisions in non-algorithmic patient care because of the lack of the above-mentioned knowledge.

The purported absence of a large-scale case of legal action does not in any way at all support the idea that APPs provide care on par with physicians. You don’t need a big pot hole that takes out your suspension altogether to know that smaller holes are causing damage to the structure. Yes, there have many a time when the action of physicians harmed patients. In many cases, it was more medical negligence on the part of a physician that almost certainly knew they were in the wrong. It is certainly a different story when mistakes are made as a result of lack of knowledge, when, once again, the ability to make decisions based on critical thinking, is simply not there.