The writers cited several reasons for their conclusion.  First, NPs do not have the same schooling as doctors especially in terms of clinical training hours.  Second, with the onset of NPs being required to have a doctorate, they potentially could be called "doctor" and that would be confusing and misleading for patients.  Finally, some NPs are in specialties and don't have the same training as doctors and may cause harm.  

Nothing was discussed of outcomes in the clinical setting because the research shows the outcomes remain equal. These studies are noted in the paper which confused me because it didn't validate their point. There is a study about NPs prescribing too many antibiotics but there is no comparable study of MDs vs NPs on this topic.  So there is no comparison and I would venture it would turn out equal.  I agree with the need for more clinical training hours for NPs.  More hours can only have a good result.  Many NPs come from strong nursing back grounds and deserve credit for their years of knowledge.  I do not support the BS/BA to MSN programs.  I have to laugh that doctors are offended by others being called doctor.  If I had a doctorate, I would still be Hari and would always introduce myself as an NP.  NPs in specialities take extra course and are usually trained and mentored by the specialty doctor.  I was an HIV/AIDS NP for many years .  I was always in a training, worked closely with a doctor and had the respect of the local medical community because I worked hard to keep current.  They also knew I was an NP and never tried to be more.  

The bottom line is economics.  The AMA feels that NPs, midwifes and PA are stealing possible healthcare dollars away.  They want to control the market  and dictate reimbursement.  NPs would not have evolved if there wasn't a need.  The need remains with many communities loosing healthcare centers and primary care providers.  NPs fill this gap.  They are able to care for people in rural America and often for the poor.  It isn't glamorous work but there is a devotion to the concept of care.  I can say as an NP when I was in practice, I knew when to ask the questions, I knew when I had reached my limit.  I never once thought of myself as a doctor.  I never wanted to.  I wanted to provide optimal care to my patients and use whatever resources I needed to reach my goal.  

The conclusion of the AMA is faulty and destructive.  If NPs, midwifes and PAs were removed from the equation a vacuum would occur.  Who would fill it?  Even if every NP was supervised, there would not be enough bodies to cover rural America and the poor.  Here's an idea.  Let's work together and get it right so healthcare is available for all who need it.