What about the doctors?

One of the possible consequences of expanding nurses’ scope of practice and allowing them to do more, medically, is reduced wages for doctors. That’s the reason for the opposition from doctors and doctors’ lobbies. The Econ 101 reasoning is pretty simple here: if you have increased supply and the same demand, supply-side takes a hit.

Via Aaron Carroll, a descriptive study about what happens when you ease scope of practice rules. (It doesn’t account for the messy confounding variables). It turns out, it’s hard to tell much: differences in wage gains, wages, etc. aren’t statistically significant.

There’s some speculation as to possible answers. One previous study cited within the study proposed the idea that physicians would substitute labor—from the nurses who could practice on their own to workers who couldn’t. (It didn’t look at employment levels or wages of nurses, unfortunately). Perhaps payers weren’t particularly aggressive in trying to substitute paying for nurses as opposed to doctors (one would imagine many patients would not be particularly excited to go to a nurse alone for many ailments and insurers might pick up on that lack of enthusiasm). Perhaps there’s something on the innovation side—if nurses were very innovative, perhaps they induced demand rather than competing for a fixed share of demand; on the other hand, perhaps nurses weren’t particularly innovative and didn’t compete enough? There are lots of questions that occur.

At any rate, the doctors’ lobbies are probably right to worry. To reprise an old chart from the NYT’s Economix blog:

As you can guess, pay for American general practitioners is well ahead of their peers worldwide, and it’s not hard to guess that that feeds into the American cost problem. American doctors would probably argue that it’s only fair—considering the debt and time burden associated with going to med school and then residency, they’re only making up for lost opportunity with their big pay. That may be so, but that doesn’t exactly dissuade you from the idea that several elements here need a rethink.