There are often statements that "five decades" of research shows the safety and efficacy of nurse practitioners and physician assistants. However, they rarely point out one important fact: That every single study on care provided by nurse practitioners and physician assistants was performed under the supervision of physicians, with access to physicians for questions or concerns, or following physician-created protocols.

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While studies DO show that NPs and PAs can provide high-quality care when working together with a supervising physician, there are no quality studies showing the safety and efficacy of non-physicians when practicing without physician supervision, following physician-created protocols, or without physician availability to answer questions and provide needed assistance.