Equivalent Healthcare Outcomes by Nurses and Physicians

Jack Cush, MD

Feb 26, 2026 5:35 pm

With increasing demand for health services in an aging population, serving complex patients with comorbidities, and increasing healthcare costs, the question of whether nurses can substitute for physicians was addressed by a recent Cochrane review.

Researchers from Ireland, United Kingdom, and Australia evaluated nurse-doctor substitution in inpatient units and outpatient clinics. The analysis included 82 randomized studies, over 28,000 patients across 20 countries. Physician outcomes were compared to "nurses" (including advanced nurse practitioners, clinical nurse specialists and registered nurses) across specialties such as cardiology, diabetes, cancer, obstetrics/gynecology, and rheumatology.

The primary endpoints were patient outcomes, process of care outcomes, and economic outcomes. This also included critical outcomes - mortality, patient safety events, quality of life, self‐efficacy, practitioner performance, and direct costs.

Meta‐analyses showed there is probably little to no difference between nurse and physician care in:

Mortality (RR 1.03, 95% CI 0.87 to 1.21);with moderate‐certainty evidence
Quality of life (SMD 0.10, 95% CI −0.04 to 0.23) with moderate‐certainty evidence
Self‐efficacy (SMD 0.01, 95% CI −0.06 to 0.09); moderate‐certainty evidence)
Patient safety events (RR 0.92, 95% CI 0.84 to 1.0) there may be little to no difference; with low‐certainty evidence

They also surmised that there may be little to no difference between nurse‐physician substitution and physician‐led care for most clinical outcomes.

In some instances, nurse‐physician substitution may result in improvements in clinical outcomes.

The certainty of evidence was low for direct costs. The direct costs (36 studies, 15,230 participants) from 17 studies showed reduced costs when physicians were substituted with nurses, with nine studies reporting increased costs owing to longer consultations, referrals, and drug prescription. The risk of bias was generally low across studies.

Although nurse‐physician substitution may result in better outcomes in certain cases, but not for all outcomes as there is still some uncertainty regarding nurse substitution for some secondary oucomes..

Substitution of nurses for physicians in the hospital setting for patient, process of care, and economic outcomes