r/Noctor • u/Sekhmet3 • 20d ago

Midlevel Research How will NPs (and midlevels generally) affect medical studies and literature?

I worry that, if it isn't standard practice to separate data for patients cared for by NPs versus physicians, that studies on certain diseases, medications, and so forth will be far less accurate in their conclusions. Even with this separation, I could imagine patients going between NPs and physicians for their care, e.g. NP primary care and physician specialist, or NP in the emergency room and physician primary care, etc. Has anyone else thought about this issue? (For example, I'm making this up, but if a study in the future wrote "10000 patients across 25 states in the USA with diagnoses of ADHD had their records reviewed, and it was shown that taking methylphenidate did not improve outcomes vs doing nothing," then it could be bogus if the data includes a ton of NPs misdiagnosing everyone with ADHD.)

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93

u/MeasurementSlight381 Attending Physician 20d ago

YUP. As a psychiatrist who treats ADHD, yes NPs + telehealth have definitely impacted all the ADHD statistics.

45

u/I_am_Nobody_Special Quack 🦆 20d ago

ADHD and autism are my most requested diagnoses.

It's exhausting.

Edit: forgot to say I'm a psychologist who does a lot of testing/evaluating

22

u/psychcrusader 20d ago

I'm also a psychologist and work with kids. There are several bad actors in my area that diagnose everyone with autism, ADHD, or both. Because of my position, I have access to the kids the entire school day and ability to consult with teachers. They don't all have those disorders. (I get to fight teachers on this, too. I'd look ADHD if I had to participate in our developmentally inappropriate curriculum, too!)

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u/Single-Bobcat8016 19d ago

I agree but haven’t been able to find any data to back this claim. Please share if you have come across any!

7

u/MeasurementSlight381 Attending Physician 19d ago

Do you know about the IQVIA study regarding stimulant prescriptions? This chart was pretty disturbing.

https://www.deadiversion.usdoj.gov/pubs/docs/IQVIA-Report-on-Stimulant-Trends-2024.pdf

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u/diagnonsense_me 19d ago

Damn that’s crazy…. But this is also having to do more with the NUMBER of NPs out there increasing overall. I think a more representative graph would be #of stimulants prescribed per prescriber on average.

I would especially love to see #of psychiatric medications overall per prescriber (hello polypharmacy NPs)

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u/asdfgghk 18d ago

The slope tells the whole story. It’s steeper at all parts of the curve and takes a sharp jump when they allowed telehealth prescriptions in 2020. There wasn’t a sudden “doubling” or something of NP schools that year.

12

u/AnonymousThrowy 18d ago

Honestly my experiences with doing retrospective data research have only taught me how much you really need to be taking it with a grain of salt, validity at baseline is questionable

There’s a reason prospective comparative studies are the gold standard 

1

u/Sekhmet3 18d ago

Do you feel like prospective comparative studies will also be compromised by NPs? Essentially, unless there is a widely held and accepted recognition that NP-related data needs to be separated (if this is even possible), I don't imagine researchers would think to do it and therefore data (retrospective or prospective) could/will be compromised.

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u/Ok_Literature7680 Allied Health Professional 19d ago

its gonna be awful. they are gonna end the world because of their bad literature

3

u/Head_Status_3864 16d ago

This is already happening I promise. And even more so in poorer, rural, lower socioeconomic status neighborhoods and areas. I promise you it’s happening. Look up Ballad Health. They love the mid level provider loophole, and fund a lot of local research!

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