Surprisingly few studies have been conducted into whether
nurse–doctor substitution saves money or reduces doctors’ workload,
but the available research suggests these gains are rarely
achieved. This is because doctors may continue to provide the
same services as nurses, leading to duplication rather than substitution
of care.9 Efficiency gains are possible only if active steps are
taken to make doctors discontinue the services delegated to nurses
and focus instead on the tasks that only doctors can perform.10 In
most studies, savings on nurses’ salaries were offset by their lower
productivity (due to longer consultations, higher patient recall
rates and increased use of tests and investigations), leading to no
overall reductions in cost. However, as salary differentials and
productivity vary from place to place, cost savings are context
dependent and may be achieved in some situations.
Surprisingly few studies have been conducted into whether
nurse–doctor substitution saves money or reduces doctors’ workload,
but the available research suggests these gains are rarely
achieved. This is because doctors may continue to provide the
same services as nurses, leading to duplication rather than substitution
of care.9 Efficiency gains are possible only if active steps are
taken to make doctors discontinue the services delegated to nurses
and focus instead on the tasks that only doctors can perform.10 In
most studies, savings on nurses’ salaries were offset by their lower
productivity (due to longer consultations, higher patient recall
rates and increased use of tests and investigations), leading to no
overall reductions in cost. However, as salary differentials and
productivity vary from place to place, cost savings are context
dependent and may be achieved in some situations.
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