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Comment by pratik661 | Hacker News Reader

Colleges increasingly using adjuncts and doctors being replaced by multiple nurse-practicioners and nurses is a PERFECT example of steps taken to mitigate the Baumol Effect.

According to the wikipedia article, these are the symptoms, effects, and remediation:

Decrease quantity/supply Decrease quality Decrease profit margins, dividends, or investment Increase price Increase non-monetary compensation or employ volunteers Increase total factor productivity

The teacher teaching Python would be an example of "increase total factor productivity". The college using adjuncts and the doctors being replaced by multiple nurse practicioners and nurses would be an example of "decrease quality". Instead of being diagnozed by a doctor, you are diagnosed by someone with less training/certification. Instead of being taught by someone who is employed full time with benefits, you are being taught by someone who is on a fixed term contract.

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There is no real scientific evidence that NPs and PAs deliver lower quality care. Patient outcomes are equivalent.

I agree 100%. I should have put "lower quality" in quotes because from an economic perspective it costs less. From an economic perspective, a "lower quality" alternative is one that costs less.

Arguably this might be a change in multi factor productivity?

This is not true "from am economic perspective", though individual studies may use "cost" as a proxy for quality.

No economist considers price the correct measure of quality, and a lot of economics deals with the often poor relationship between the two (and the factors subsidising the mismatch).

To expand further on the absurdity mentioned in my other comment: Before germ theory was known, maternity wards where baby deliveries were done by doctors had higher mortality rates for mothers and babies than wards where the deliveries were done by relatively "untrained" midwives (because doctors worked with cadavers and didn't wash hands).

However, from a certain economic standpoint, the midwife service would be considered "inferior" to the doctors service due to the difference in training and licenses.

This is a very polarizing topic in the field of medicine, especially when it comes to independent practice of midlevel providers. I’d just point out that NPs have a very aggressive national organization that promotes such studies, and the issue of equivalent patient outcomes is certainly not yet decided. There are significant questions about the study design, namely that midlevel providers are seeing less complex and critical patients, while physicians take on cases where their more advanced and thorough knowledge is needed (and outcomes tend to be poorer due to the patient condition, not the care provided).

This is well and good, aside from potentially misrepresenting the research - midlevels are supposed to handle what they can and escalate what they’re unable to handle to a supervising physician.

There is similar research that shows NPs and PAs order more unnecessary diagnostic tests like labs and imaging, and are more likely to prescribe antibiotics and narcotics when it isn’t indicated.

It’s entirely possible that the results/education curve is log/log complex, and that therefore because human biology is so complex and we know relatively so little, it doesn’t matter too much how trained the person working on you is (on average) past some baseline that might be lower than expected.

I understand what GP means.

But I would rather put it in the "increase total factor productivity" category.

The idea here is that nurses are less costly than doctors: less training, lower barrier to entry, etc... And presumably, with the new organization, you are able to get the same quality of care with more nurses and less doctors. It is actually an increase in productivity: equivalent outcome for cheaper.

That's understandable, but then it's kind of misleading to represent any of those professions as a curve on a graph, if the profession is constantly redefining itself.

But now I just noticed that the graph represents products and services, not professions or workers. So we're not talking about the internal cost structure of those industries, but simply their price. I might be mis-reading the whole thing.

Oddly enough the outstanding curves on that graph are ones where the "market" is an archaic mixture of private and public entities with little resemblance to free markets.

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