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In Reply: Dr Perkins recognizes the impending crisis in primary care delivery in the United States and proposes that a solution to the low interest in primary care careers among current medical students is for physicians to relinquish the role to nurse practitioners and physician assistants. Although one study with brief follow-up found that the clinical outcomes of care by nurse practitioners were equivalent for certain conditions compared with the care provided by physicians,¹ a Cochrane Collaboration review advised caution because most studies were methodologically flawed and of short duration.² We believe that it is premature and risky to generalize these limited results to the typical populations internists serve, with their multiple, complex, and chronic medical problems.

Additionally, this solution fails to address the many problems burdening the health care system. Replacing primary care physicians with advanced practice nurses will not address the challenges of caring for large numbers of . . . [Full Text of this Article]

Karen E. Hauer, MD
khauer@medicine.ucsf.edu
University of California, San Francisco

Steven J. Durning, MD
Uniformed Services University
Bethesda, Maryland

Mark D. Schwartz, MD
New York University
New York, New York

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