Intended for healthcare professionals

Observations Letter from New England

What a doctor is good for

BMJ 2014; 349 doi: (Published 19 November 2014) Cite this as: BMJ 2014;349:g6894
  1. David Loxterkamp, medical director, Seaport Community Health Center, Belfast, Maine
  1. david.loxterkamp{at}

With growing numbers of physician assistants and nurse practitioners, what do doctors add?

Over the years I have served as both a preceptor and colleague for more than a dozen physician assistants and nurse practitioners. All the while I wondered: are they as good as they seem, and are doctors as indispensable as we’d like to believe? When my daughter became a physician assistant I was forced to respond.

I share a small practice with six family physicians. Each of us works closely with a designated medical assistant. Around us, personal service representatives greet our patients and schedule their visits; billing associates ensure our financial survival. We also rely on a physical therapist, pharmacist, behavioral therapist, triage nurse, care manager, health coach, laboratory technician, medical records clerk, clinical coordinator, and practice director. Thus, you can forgive the doctor, let alone his or her patients, for sometimes getting lost in the shuffle.

Increasingly, advanced nurse practitioners and physician assistants will join the clinical team. One of each is now on our staff. In the United States, more than 165 training programs have …

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