On/Offcall: The Rise of NPs and PAs Is Not the Solution for Healthcare

Welcome back to On/Offcall!

This week, I tackled a controversial topic for physicians: the growth of non-physician practitioners like nurse practitioners and physician assistants.

No surprise to this newsletter audience, but the physician workforce has remained flat for the past few decades while there’s been a significant increase in NPs and PAs. It’s easy to see why hospitals would adopt this strategy to save money, but I feel strongly that this approach comes at the expense of long-term patient safety and care quality. To be clear, NPPs play an important role in medicine but rather than short-changing or replacing physicians, I’d like to see a more balanced system that serves patients’ best interests and ensures that all providers — physicians, NPs, and PAs alike — get placed in roles that reflect their training and match their abilities.

My new essay on why physicians are angry and frustrated about the rise of NPPs includes my own ideas about a better path forward, and I’d love to hear yours: Leave me a comment or send me your feedback directly (graham@offcall.com)!

Graham Walker, MD, Emergency Physician
Co-founder, Offcall

Dr. Phil DiGiacomo Opens Up About Burning Out of Clinical Medicine

This week, How I Doctor featured Dr. Phil DiGiacomo, an emergency physician who left medicine for a non-clinical career after burning out. This episode is a must-listen for any physician who’s burned out, considering side jobs, or in the midst of a significant career pivot. Phil was vulnerable, open, and his story has inspired powerful reactions:

@Yvonne Gruendler: “Much love to anyone who's feeling their job/profession is not a good fit and hope you find a better fit! ❤️ ”
@Somya Ramrakhyani: “Phil’s openness about his journey and burnout is a reminder that it’s okay to prioritize your well-being.”
@Eric Arzubi, MD: “This work is brutal and forces us to think hard about our purpose every day. Phil's vulnerability is a great example for us all.”
@David Carnahan, MD MSCE: “After almost 20 years in Internal Medicine, I made the switch to Informmatics. I was having a blast, but I remember when I ran into a colleague, we were in the same residency class and he said, "Oh, so you're not a doctor anymore." There are a lot of people who will look at things that way but you have to not let them define you or your path.”
@Laura Posidelow: “I made the same move in 2020. Can't say I ever think about returning.”

Thanks to everyone who shared your own experiences openly and honestly.

Listen to the episode →

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3 Things to Read This Week

How Patient Care Changed After Private Equity Bought Hospitals (JAMA) →
A new study confirms PE’s growing presence might be leaving patients worse off.

The Most Popular Physician Side Gigs, Charted (Medscape) →
Doctors are working after work to make extra money, build back-up their careers, and to just have fun.

Clinician Turnover 2024 (KLAS Arch Collaborative) →
The risk of turnover among doctors and nurses has risen to nearly 50%, according to a new report digging into alarming career trends. (h/t @Dr. Tina Shah)

Highlights From Our Community

Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Reply and we’ll feature you.

🎙️ Tune In: Matthew Sakumoto and Anwar Jebran
Dr. Matthew Sakumoto and Dr. Anwar A. Jebran launched ACP + Innovation, a new podcast about healthcare IT, clinical informatics and innovation. Tune in!

📺 On the Nightly News: Brad Goldberg
Dr. Brad Goldberg appeared on NBC Nightly News with Lester Holt talking about L.A. wildfires and emergency preparedness. Watch here (11:57). He’s also quoted in the WSJ talking about the impact of the fires on L.A.’s children.

💪🏼 Thank You, Tina Wu
Emergency physician Dr. Tina Wu has been on the frontlines of the L.A. wildfires and offered these words of grace and bravery. We’re grateful to you and your colleagues.

📚 Way to go, Uche Blackstock
Dr. Uche Blackstock is kicking off a new book tour for Legacy which explores how “the history of emergency medicine is bound up in the experiences of Black and Latinx communities’ exclusion from the healthcare setting.” Get your ticket.

🎉 Congrats Ankoor Shah
Dr. Ankoor Shah launched a new Substack about the “fundamental truths in healthcare” called The Healthcare Contrarian. Check it out.

👏🏼 Bravo, Neel Shah
Dr. Neel Shah makes a bold prediction that we’re likely to see more clinician influencers active on social media this year. We couldn’t agree more :) Read his 2025 predictions.

🎉 Overheard at JPMorgan
Dr. Raihan Faroqui co-hosted a physician innovator mixer with MedMountain Ventures on the sidelines of the JPMorgan healthcare conference in S.F. What a room of physician innovators!!

🎈 Career Moves, Congrats!
→ Dr. Yana Vaks, a pediatric critical care physician, is the new Assistant Physician in Chief at The Permanente Medical Group.
→ Dr. Kai Romero, an emergency and hospice physician, is joining Evidently as the Head of Clinical Success.
→ Dr. Srinath Adusumalli, a cardiologist-informaticist, is the new VP and Chief Health Information Officer at Penn Medicine.
→ Dr. Justin Norden, a physician-entrepreneur, launched Qualified Health to “build the infrastructure for generative AI in healthcare.”

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