Quote card by Opinion.

While on a U-M Blue Bus bound for North Campus on a particularly pleasant day, I decided to enjoy the ride free of distraction. I put my AirPods away, cracked open the window and took in the breeze of the Huron River running parallel to me. My moment of meditation was cut short, however, by a group of students on the bus who had just been dismissed from an organic chemistry lab. After a normal discussion about titrations, the post-lab discussion write up and weekend plans, one of the students began recounting an experience they had at University Health Services that morning.

“I bet she was just pretending to know how to use the stethoscope,” he said.

“There’s no way a PA should be able to run an entire appointment. I’m telling you guys — our tuition money is being wasted.”

After the student finished his tirade against the UHS physician assistant who treated him for an ear infection a few hours before their lab, his fellow classmates began to chime in. “I just can’t believe we have to settle,” “there are no real doctors left in primary care” and “let’s boycott UHS,” were among the statements made.

The students were quite a few rows ahead of me, but their disdain traveled throughout the whole bus with the shock-factor of a code blue alarm. Their blatant disregard for and disparaging attitude toward advanced practice providers such as nurse practitioners (NPs) and physician assistants (PAs) that serve a critical role at UHS horrified me. Those students’ words shed light on the crux of a big problem: the disintegration of respect for team-based healthcare.

I, like the students on the bus, am a pre-medical student. I would hope that all future physicians choose a career in healthcare to be, at the core, a patient advocate. However, advocacy is never a one-man show. From the moment of initial malady all the way until the discharge papers are in hand, patients are assigned a comprehensive team of people championing for a full recovery: physicians, nurses, PAs, NPs, patient care technicians, case workers, physical, occupational and respiratory therapists, food service workers, janitors, security and so on. 

It is clear that healthcare cannot function without collaboration. Despite this fact, a dangerous precedent is being adopted by pre-medical students to treat certain valued members of the team as less than. This mistreatment is derived from a belief in the concept of “scope creep,” the idea that non-MD healthcare professionals with advanced degrees (like NPs and PAs) are taking over duties and responsibilities traditionally held by physicians alone. On one hand, midlevel providers can address physician shortage by providing more access to primary care procedures and streamline treatment time by putting in medication orders, performing exams, ordering labs, conducting physicals and paging specialty consults. However, the incorporation of midlevel providers with little to no physician oversight has, according to critics of scope creep, led to severe misdiagnoses, inaccurate drug prescriptions, over testing and adverse patient outcomes. Physicians against midlevel encroachment often cite an unstandardized curriculum, short clinical exposure, completely virtual degrees and the lack of residency as reasons to push back against NPs and PAs in an independent context. 

There is much more nuance to the “scope creep” discussion than I, as an undergraduate, can speak to. This isn’t an article championing for NPs and PAs to expand their scope of practice, nor is it a conduit for damaging discourse about potential shortcomings of midlevel providers. What I am certain of, however, is that, at Michigan Medicine and UHS alike, nurse practitioners and physician assistants aid physicians in providing services to the over 40,000 students on campus. NPs and PAs are part of a world-renowned medical enterprise that is at the forefront of healthcare services in the state of Michigan, and their contributions should not be questioned.

As of today, UHS provides ambulatory care that takes the form of eye/optical, gynecological, sexual, laboratory, nutritional, pharmacy, physical therapy, psychiatry, sports medicine, dermatology, immunization and LGBTQ-focused care. According to their website, UHS facilitates over 30,000 primary care visits, 43,000 tests and 18,000 prescriptions in a calendar year, all supported by a variety of non-MD clinicians. Without NPs and PAs at UHS, students in need of health services would have to wait months to be seen by physicians who, by time of appointment, would be extremely overworked with an increased caseload.

At this stage in our undergraduate career, the minds of pre-med students are crucial in forming the thoughts and opinions of physicians we aspire to be one day. The rhetoric used by vehement critics of the work midlevel providers do at UHS preemptively pits premedical students against our pre-PA, nursing and pre-health classmates. The students on the bus are at the beginning stages of an “us versus them” mentality that has stressed the fabric that holds team-based healthcare together: respect. 

Instead of bickering over the data for and against various models of care, we need to first establish, wholeheartedly, that NPs and PAs are vital members of the team and deserve the same level of regard that other clinicians receive. If we affirm every individual member and their unique mission in the team at-large, the right level of collaboration between physicians and other clinicians will fall into place — with respect being the component that levies it.

To all the clinicians at Michigan Medicine and UHS, I sincerely thank you. The level of care, professionalism and attention I have received from you has greatly informed the way I hope to practice medicine one day.

Namratha Nelapudi is an LSA Junior and can be reached at nelapudi@umich.edu