Padma Ramaswamy, a nurse practitioner, examines Andrew Chavaria at Legacy Clinic Southwest in Houston. A new study highlights nurse practitioners and other non-physicians. Eric Kayne 
 
 Midwives, nurse practitioners, physician assistants and other non-doctors do as good a job as MDs in the care they deliver — and patients often like them better, a World Health Organization team reported on Thursday. 
 
 These non-physicians are especially effective in delivering babies, taking care of people infected with the AIDS virus, and helping people care for chronic diseases such as diabetes and high blood pressure, the team reported in a WHO bulletin. 
 
 The findings extend from the poorest nations to the United States and Europe, they said. While some physician groups have resisted wider use of such professionals, they should embrace them because they are often less expensive to deploy and are far more willing to work in rural areas, the WHO experts said. 
 
 “There are some obvious advantages in terms of relying on mid-level health workers,” WHO’s Giorgio Cometto told NBC news in a telephone interview. 
 
 “They take less time to be trained. Typically, they cost less to remunerate. In some countries they are more likely to be retained in rural areas.” 
 
 David Auerbach, a researcher at the Rand Corp., says other studies have shown the same thing. “There’s really not much difference you can find in the quality,” he said. 
 
 Doctors are scarce in the United States. The Association of American Medical Colleges projects a shortfall of 90,000 physicians by 2020. Family practitioners and other generalists are especially scarce, and experts predict it will only get worse as millions of Americans get health insurance under the 2010 Affordable Care Act. 
 
 Doctors are also scarce in the developing world, and many countries are looking for ways to fill gaps. 
 
 Cometto and colleagues around the world looked at all the studies they could find on the quality of care delivered by non-physicians. They settled on 53 that looked specifically at the quality of care delivered — and at how happy patients were with the care they got. 
 
 “The evidence shows there aren’t statistically significant differences,” Cometto said. “The quality of care they provide is comparable to physicians. In some cases, for specific services, they actually outperform physicians.” 
 
 For instance, nurse-midwives or midwives who deliver babies end up using fewer drugs and they are less likely than doctors to make a type of cut called an episiotomy. Groups such as the American College of Obstetricians and Gynecologists recommend against episiotomies because they don’t heal as well as the natural tears that occur during childbirth. 
 
 Midwives were no more or less likely than doctors to induce labor, perform cesarean sections or use instruments to deliver a baby, Cometto’s team found, and the rates of death of either mother or child were the same among doctors as among midwives. 
 
 There were similar findings for treating patients infected with the human immunodeficiency virus (HIV) that causes AIDS. “One study compared the effects of antiretroviral therapy (ART) in patients managed by nurses and those managed by doctors. There was no significant dif­ference in the likelihood of ART failure between groups of patients managed by nurses and those managed by doctors,” the researchers wrote. “Nor was there any difference in mortality, failure of viral suppression or immune recovery between the groups.” 
 
 When it came to caring for heart disease and diabetes, patients actually seemed to like nurses and other non-doctors better, the report found. This jibes with what nurse-practitioners and physician assistants working in the United States report. “We look at patients in a more holistic manner,” Judy Honig, associate dean at the Columbia University School of Nursing, said in a recent interview. 
 
 The Institute of Medicine, which advises the federal government on health matters, says nurses can do more than they already do and can help meet ballooning demands as the population ages and as more people get health insurance and start seeking care. 
 
 The United States has more than three million nurses. They already deliver much of the front line health care that Americans need, from giving vaccinations to delivering babies. 
 
 Nurse-practitioners are registered nurses who hold graduate degrees and can perform virtually all of the functions of front-line family doctors — depending on the laws of the state they’re in. 
 
 Between 1998 and 2010, the number of Medicare patients treated by NPs increased 15-fold to more than 450,000 people, University of Texas Medical Branch researchers found recently. Groups such as the American Association of Nurse Practitioners are calling for even more to be trained. 
 
 Physician assistants are also seen as offering a big plug in the health care hole “Currently, there are more than 93,000 PAs throughout the U.S. whose education in general medicine prepares them to be extremely nimble, positioning them very well to address an influx of 20 million new patients entering the health care system,” says Lawrence Herman, president of the American Academy of Physician Assistants. 
 
 
 
 Rand’s Auerbach says integrated clinics, using electronic health records and other technology, can really help fill the gaps. But he notes that not all medical groups are on board with the idea. 
 
 
 
 “It’s getting over a cultural barrier and learning how to work in teams of providers with different expertise,” Auerbach said. “That is not trivial.” 
 
 The American Society of Anesthesiologists recently spoke out against what it sees as the overuse of nurse-anesthetists. “Somehow there has become the notion that you can take physician extenders and replace physicians,” said Dr. Jane Fitch, a former nurse anesthetist who is now a physician anesthesiologist. “We are really concerned about patient safety.” ||||| This news release is available in Spanish, French, Portuguese and Arabic. 
 
 Countries facing severe shortages and poor distribution of health workers could benefit from training and deploying more mid-level health workers, such as midwives, nurses, medical assistants and surgical clinicians, according to a study published in the Bulletin of the World Health Organization today. 
 
 In countries where such health workers have been deployed, the clinical outcomes for certain services were just as good and – in some cases – even better than when physicians performed them, the study shows. 
 
 "Our findings de-bunk the myth that more extensive use of mid-level health workers might lead to services of poorer quality; despite the limitations of the evidence, it seems that in some areas they actually out-performed physicians," said lead author Dr Zohra S. Lassi, Senior Instructor in the Division of Women and Child Health at the Aga Khan University in Karachi, Pakistan. "Most of our findings point to opportunities that all countries – rich and poor alike – can exploit." 
 
 The study shows that when care for mothers and newborn babies is provided by midwives, as opposed to physicians working with midwives, the rates are lower for episiotomy (a surgical incision to ease a baby's delivery that can lead to complications) and the use of painkillers. In addition, patient satisfaction is often higher, the study shows. 
 
 Another important finding is that care provided by nurses in various fields of health – including prevention and treatment of heart disease, diabetes, mental health conditions and HIV infection – is as effective as that provided by physicians. There is no suggestion in the study that physicians should be entirely replaced by mid-level health workers but that in certain health areas mid-level health workers do just as well, if not better than physicians. 
 
 The study is one of a collection of articles in a special issue of the international public health journal devoted to the topic of: the health workforce needed in countries to move towards or sustain universal coverage of health services. The new study analyses 53 studies conducted in 18 countries over the last 20 years comparing the outcomes of certain types of care provided by mid-level health workers and of the care provided by physicians. It is the first systematic review – a study that analyses all the available evidence – to make such a comparison. 
 
 Most of the studies analysed compare either: the care provided by midwives with that provided by doctors working in a team with midwives; or, the care provided by nurses with that provided by doctors. 
 
 More than half of the 53 studies were done at tertiary care facilities in high-income countries (Australia, Canada, Italy, the Netherlands, Sweden, the United Kingdom and the United States of America). The rest were in middle-income (Cameroon, China, the Philippines, South Africa, Thailand, Turkey and Viet Nam) and low-income countries (Malawi, Mozambique, Nepal and the United Republic of Tanzania), according to the World Bank income level categories. The study's results are particularly relevant for countries striving to provide their people with universal access to affordable, quality health-care services – an endeavour for which a suitable health workforce is a key component. In 2012, the United Nations General Assembly adopted a resolution urging governments to commit themselves to universal health coverage. 
 
 "Moving towards or sustaining universal health coverage is a challenge for all countries: traditional models of care, dominated by physician-led provision of expensive curative services in tertiary care facilities, have their limitations," said Dr Giorgio Cometto, adviser to the executive director of the Global Health Workforce Alliance, a WHO partnership. 
 
 "But when mid-level health workers are given a more prominent role, health-care services may respond better to citizens' needs – and this approach may also save money in the long-run," said Cometto, who is also one of the authors of the study. WHO encourages all countries to adopt the most efficient mix of health-care skills and cadres possible to address the health needs of their populations. It has issued recommendations on the delegation of tasks from one type of health worker to another in the care of HIV infection, and maternal and newborn health and offers technical support to countries facing health workforce challenges.
– Not only do midwives, nurse practitioners, and physician assistants do as good a job as doctors, they sometimes do better—and patients would agree, according to a World Health Organization bulletin. NBC News gives an example: When it comes to delivering babies, midwives use less drugs and perform fewer episiotomies than doctors, and the mother/child death-rate was no different among the two groups. Further, patients were often reported higher satisfaction with midwives. The findings come from a review of 53 studies conducted over the last two decades that focused on the quality of care, and "debunk the myth that more extensive use of mid-level health workers might lead to services of poorer quality," the bulletin reads, per Science Codex. "The quality of care they provide is comparable to physicians." To boot, these mid-level health workers are cheaper, take less time to train, and are more willing to work in rural areas. It's a conclusion that all countries, including the US "can exploit," says the WHO; to wit, NBC News points out a shortfall of 90,000 doctors is predicted in the US by 2020.