"Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. If you show up at an urgent care, just expect that you will be treated by a LPN and a PA or a NP. A Family Practice physician's salary is about comparable to a Sr. Engineer at many tech companies (~160k), and they can have significant malpractice insurance overhead and insane hours. A PA or NP still makes 6 figures, so the "savings" just aren't there.

If you've ever had to attend something like Physical Therapy, you'll see the actual PT (a MS/Doctorate level professional aka DPT) about twice. Once for an eval, and once for a discharge. An "aide" will guide you through all the other exercises, and they make very significantly less than a PT.

The savings are mysteriously gone, even adding lower-salaried professional extenders.

> “Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper.

This needs the caveat of “to American consumers”. The NHS seem to be heavily moving in that direction, and I suspect “cheaper” is no small part of that

"professional extenders" are often "profit extenders", as the supervising physician can enable his / her practice to see more volume and better match revenues and costs (ie have lower cost labor do lower revenue / acuity work). the "savings" from this often end up accruing to the owner of the practice. increasingly this owner is a large hospital system, but they take this delegation a step further, using lower cost primary care as a way to increase volume to higher acuity / reimbursed hospital procedures.

The Minute Clinics are staffed by nurse practitioners and physician assistants

https://www.cvs.com/minuteclinic/why-choose-us/our-practitio...

To expand their services to all of their stores, they'd be looking at hiring 5 or 10 percent of the NPs and PAs in the country.

Or...the publically signaled demand for those relatively high paying jobs would encourage more people to seek training for those opportunities.

These aren't easy roles to get into. The educational requirements are pretty high (MS or PhD) and the courses are rigorous. The educational requirements are close enough to an MD that I'm sure most people considering being an NP from the onset also debate just getting an MD.

The minimum requirements of a RN is an Associates degree and successful completion of the NCLEX -- though, many hospitals require a person to also obtain a BSN after a few years to continue being employed. That's a big educational jump to make.

I don't think pay is a big motivator for nurses. There are so many better paying jobs out there that are easier to get, and don't involve dealing with the figurative and literal shit nurses deal with daily.

Or, the high price may be from administrative costs:

http://www.nejm.org/doi/full/10.1056/NEJMp1209711

Do a search for "McKinsey health costs" and browse the report. It breaks down category spending in the US vs. other western countries. Yes, admin cost more in the US, but it doesn't add much to the overall costs. The biggest driver of US healthcare spending are out-patient care. The US just does a shit-ton more of it then most countries.

I've seen at least one healthcare economist claim that admin costs account for roughly 25% of spending. Is this in line with what you see there?

'Even' a paramedic?

While we might cost about the same, our scope of practice is a lot broader than an LPN's...

Nursing unions and trade groups are generally very opposed to the 'paramedic practicioner' or 'community paramedicine' model.