148588 tn?1465778809

Midwives and nurses are as good as docs -- and sometimes better


"Midwives, nurse practitioners, physician assistants and other non-doctors do as good a job as MDs in the care they deliver — and patients often like them better, a World Health Organization team reported on Thursday.

These non-physicians are especially effective in delivering babies, taking care of people infected with the AIDS virus, and helping people care for chronic diseases such as diabetes and high blood pressure, the team reported in a WHO bulletin.

The findings extend from the poorest nations to the United States and Europe, they said. While some physician groups have resisted wider use of such professionals, they should embrace them because they are often less expensive to deploy and are far more willing to work in rural areas, the WHO experts said.

“There are some obvious advantages in terms of relying on mid-level health workers,” WHO’s Giorgio Cometto told NBC news in a telephone interview.

“They take less time to be trained. Typically, they cost less to remunerate. In some countries they are more likely to be retained in rural areas.”

David Auerbach, a researcher at the Rand Corp., says other studies have shown the same thing. “There’s really not much difference you can find in the quality,” he said.

Doctors are scarce in the United States. The Association of American Medical Colleges projects a shortfall of 90,000 physicians by 2020. Family practitioners and other generalists are especially scarce, and experts predict it will only get worse as millions of Americans get health insurance under the 2010 Affordable Care Act.

Doctors are also scarce in the developing world, and many countries are looking for ways to fill gaps.

Cometto and colleagues around the world looked at all the studies they could find on the quality of care delivered by non-physicians. They settled on 53 that looked specifically at the quality of care delivered — and at how happy patients were with the care they got.

“The evidence shows there aren’t statistically significant differences,” Cometto said. “The quality of care they provide is comparable to physicians. In some cases, for specific services, they actually outperform physicians.”

For instance, nurse-midwives or midwives who deliver babies end up using fewer drugs and they are less likely than doctors to make a type of cut called an episiotomy. Groups such as the American College of Obstetricians and Gynecologists recommend against episiotomies because they don’t heal as well as the natural tears that occur during childbirth.

Midwives were no more or less likely than doctors to induce labor, perform cesarean sections or use instruments to deliver a baby, Cometto’s team found, and the rates of death of either mother or child were the same among doctors as among midwives.

There were similar findings for treating patients infected with the human immunodeficiency virus (HIV) that causes AIDS. “One study compared the effects of antiretroviral therapy (ART) in patients managed by nurses and those managed by doctors. There was no significant dif­ference in the likelihood of ART failure between groups of patients managed by nurses and those managed by doctors,” the researchers wrote. “Nor was there any difference in mortality, failure of viral suppression or immune recovery between the groups.”

When it came to caring for heart disease and diabetes, patients actually seemed to like nurses and other non-doctors better, the report found. This jibes with what nurse-practitioners and physician assistants working in the United States report. “We look at patients in a more holistic manner,” Judy Honig, associate dean at the Columbia University School of Nursing, said in a recent interview.

The Institute of Medicine, which advises the federal government on health matters, says nurses can do more than they already do and can help meet ballooning demands as the population ages and as more people get health insurance and start seeking care.

The United States has more than three million nurses. They already deliver much of the front line health care that Americans need, from giving vaccinations to delivering babies.

Nurse-practitioners are registered nurses who hold graduate degrees and can perform virtually all of the functions of front-line family doctors — depending on the laws of the state they’re in.

Between 1998 and 2010, the number of Medicare patients treated by NPs increased 15-fold to more than 450,000 people, University of Texas Medical Branch researchers found recently. Groups such as the American Association of Nurse Practitioners are calling for even more to be trained.

Physician assistants are also seen as offering a big plug in the health care hole “Currently, there are more than 93,000 PAs throughout the U.S. whose education in general medicine prepares them to be extremely nimble, positioning them very well to address an influx of 20 million new patients entering the health care system,” says Lawrence Herman, president of the American Academy of Physician Assistants.

Rand’s Auerbach says integrated clinics, using electronic health records and other technology, can really help fill the gaps. But he notes that not all medical groups are on board with the idea.

“It’s getting over a cultural barrier and learning how to work in teams of providers with different expertise,” Auerbach said. “That is not trivial.”

The American Society of Anesthesiologists recently spoke out against what it sees as the overuse of nurse-anesthetists. “Somehow there has become the notion that you can take physician extenders and replace physicians,” said Dr. Jane Fitch, a former nurse anesthetist who is now a physician anesthesiologist. “We are really concerned about patient safety.”
8 Responses
Sort by: Helpful Oldest Newest
649848 tn?1534633700
Typically, I've found that I like a lot of the NP's, ARNP's and PA's a lot better than the doctor himself.  The "assistants" don't tend to have the
"holier than thou, know it all" attitude of a doctor (or most I've had), and they tend to have much better bedside manner, they listen to the patient better and are more willing to order tests and try things.

If I were having a surgery or something, I'd want the trained doctor to perform that surgery and I'd want a doctor administering the anesthesia, though I wouldn't mind having someone "in training" under the VERY DIRECT, HANDS ON, supervision of the doctor; but for general care, I'm fine with the NP, ARNP or PA, as long as they are willing to refer me to a specialist when they get out of their realm (I even had a doctor who refused referral to a specialist, when he didn't know what to do -- thought he was going to kill me).

Of course, you have to take the  money into consideration.  If NP's, ARNP's and PA's start handling primary care, or even specialized care, the prices won't go down, because they have to work with a physician who reviews their cases.  I've seen that from my own doctor's visits.  In fact, just Tue I had an appointment with a neurologist, but I saw the PA, instead.  My part of the bill was still over $300 and I have pretty good insurance, though I had nerve conduction tests and haven't met my deductible for the year.
Helpful - 0
973741 tn?1342342773
When I had my second child, I had a 'nurse in training'.  Nothing like hearing "Uh oh" when being cathed.  Good times.

If they keep the Pa/NP standards high, I think they are helpful.  Definitely can handle much of the easier stuff of a general practitioner's load.  The routine diagnosing of ear infections and antibiotics written and that type of thing.  More complicated situations, I want the most experienced, most trained, most educated person I can get and that really is usually a doctor.

I think Midwifery is great.  Honestly, it was my OB nurses that did so much of the work when I had my kids.  Now, I had complications with one and was older with both so would never have had my kids anywhere but a Tier 3 hospital just in case. My first child really put us through the ringer and a Midwife would have turned us over, I'm sure, to an MD.  As long as they will do that if necessary, I think it is a great practice.

But what will be interesting is what malpractice insurance will do with these types of specialties.  There's a shortage of Ob's because of such high malpractice insurance.  Seems to be a risky specialty for getting sued and I'd imagine that Midwives will be subjected to the same.  ???  
Helpful - 0
163305 tn?1333668571
Not surprising.
My second child was delivered at home. It was so much easier than being in the hospital !!!
Helpful - 0
148588 tn?1465778809
My daughter was delivered by a midwife and an RN/midwife (and my white knuckled assistance). 1,000+ births experience between the two of them. I have nothing but good to say about that vocation.
Helpful - 0
377493 tn?1356502149
I would have opted for a midwife had I not had pregnancy complications.  My son would not be here had I not had him in a hospital, and medical intervention.  I think Nurses, Dr.'s and Midwifes all have their place in our medical system and do feel fortunate to be able to choose that which works best for me.
Helpful - 0
206807 tn?1331936184
All 3 of mine were Born at Home (God Strike Me Dead if I’m Lying). We had a Midwife for Joe (Josiah) and I delivered Leah and Anna myself. After all of the courses, research, and classes we took, 30 years later, we still believe we made the right choice. After questioning her OBGYN, my wife and me had more answers than her. I knew what to look for if they were breach, she didn’t and said would do a C Section. I could feel there head was in position just by feeling her stomach. Cord wrapped around the neck twice? Two pairs of Hemostats and cut in the middle. My youngest was wrapped once; I pulled the cord over her neck and the next contraction she was out. That would be Anna. Even though I have Rode thousands of miles with Joe, Anna is my favorite. She is a femaile version of me. A little complicated, a Liberal that hates Obama. Her Homo friends respect me because I don’t bite my tongue and respect that I’m “Old School” My oldest Daughter, let’s just say, she takes more after her Mother’s side of the Family.
Helpful - 0
377493 tn?1356502149
That is super cool, it truly is.  What a beautiful bond you must have with your children having actually delivered them!  A lot of my colleagues at work now labor and deliver at home, and wouldn't have it any other way.  
Helpful - 0
Avatar universal
Glass, what a wonderful story. It has always been apparent to me that you are bonded with your kids in a special way , especially the daughter (Your funny Christmas tree story)
Just like women can bond with their babies without nursing, I know that men love their kids just as much if not present at their birth, but my experience with parents who are there and engaged in the experience has been that they are affected by something profoundly beautiful. Thanks to you (and desrt) for sharing it with us.
Helpful - 0
You must join this user group in order to participate in this discussion.

You are reading content posted in the Current Events . . . Group

Didn't find the answer you were looking for?
Ask a question
Popular Resources
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Can I get HIV from surfaces, like toilet seats?