Doctor Shortage? No Problem
[Guest post by DRJ]
Following a recent report that ObamaCare could result in a shortage of 150,000 or more doctors in the next 15 years, 28 states may expand the authority of nurse practitioners:
“For years, nurse practitioners have been playing a bigger role in the nation’s health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.
Those newly insured patients will be looking for doctors and may find nurses instead.
The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.
Nurse practitioners argue there’s no danger. They say they’re highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.”
Some argue a nurse practitioner-based system would not only be cheaper but also better for patients:
“What’s the evidence on the quality of care given by nurse practitioners?
The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.
“The argument that patients’ health is put in jeopardy by nurse practitioners? There’s no evidence to support that,” said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.
Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.”
Someone will have to treat all those new patients if ObamaCare takes effect.
— DRJ
Not to worry. You’ll be treated by Nurse Jackie at one of the 60 new hospitals under construction.
Or not.
GeneralMalaise (a1a83b) — 4/13/2010 @ 2:56 pm“Seldom do businessmen of the same trade get together but that it results in some detriment to the general public”
Adam Smith
TomHynes (2e563b) — 4/13/2010 @ 4:47 pmall i know is that i have more “nurse” horror stories than i do “doc” ones.
redc1c4 (fb8750) — 4/13/2010 @ 4:53 pmsome NP’s are great, just as some docs are terrible, but unless it’s something routine, such as “yes you have a fever” or “that’s a horrible case of athlete’s foot, lets do a liver panel and put you on Lamisil”, i’d rather see a doc to play “make that diagnosis”.
besides, once they start cutting reimbursement, and thus salaries, who’s gonna want to be an NP OR a doctor?
I’m sure you’ll recommend Dr. Terrence Lakin. Great guy, eh.
Larry Reilly (fadcab) — 4/13/2010 @ 4:59 pmI recommend Dr. James Herriot for you, Reilly, ya mutt. You deserve the best.
I’m told he’s got spaying at half off, better hurry.
GeneralMalaise (a1a83b) — 4/13/2010 @ 5:16 pmYou’d think someone would tell Obama to quit pissing off India, since it will become the source of our doctors.
SPQR (26be8b) — 4/13/2010 @ 5:45 pm“If you like your doctor, you can keep your doctor.”
–lie #70,892 from President Barack H. Obama
no one you know (4186cd) — 4/13/2010 @ 6:27 pm“If you like your doctor, you can keep your doctor.”
…except that all of our doctors will be retiring from medicine.
Dana (1e5ad4) — 4/13/2010 @ 6:30 pmIn my experience, NPs are used by big groups to deny the patient antibiotics or other expensive treatment. Gatekeepers.
I went to a new doctor group after I got the runaround from the NP at my old place.
Patricia (fa8e06) — 4/13/2010 @ 6:40 pmI saw this coming a long time ago.
As Obamacare goes into full swing, and Congress cuts the budget to make the books balance (starting with physician reimbursement… because nobody gives a damn if doctors making less money… until they can’t find one.), it simply won’t make economic sense for physicians to go into primary care.
Hell… it already doesn’t make economic sense. Rack up six-figures of debt, just to work like a dog for 10-15 years to pay it off? (while getting screwed by Medicare and every other third-party-payor)
Thus, primary care will get pushed down to the PA/ARNP level. Not that there’s anything necessarily wrong with those folks… they ARE cheaper (Medicare cuts 15% off their already-low reimbursement for a patient seen by a “physician extender” rather than the doctor).
They’re also not as extensively trained as a physician. And before any Nurse Practitioners or PAs’ reading this get in a huff, just go ahead and compare your six-year degree to the physician’s 11 years.
TheNewGuy (114368) — 4/13/2010 @ 6:46 pmI’ve always had confidence in the nurse practitioners and physician assistants that I’ve worked with and have enjoyed it. For awhile now I have raised these routes of training as possibilities for anyone thinking about going into medicine.
That said, the amount of time and intensity of training for an NP or PA is significantly less than an MD/DO. This is usually reflected in the breadth of knowledge and experience a doctor has over an NP/PA, and why usually the PA/NP works in a limited scope associated with a doctor/doctors.
“Nurse practitioners argue there’s no danger. They say they’re highly trained and as skilled as doctors at diagnosing illness during office visits.” They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less
Sorry, I don’t believe that someone with 1/2 or less the hours of training is going to be “just as good” at anything, whether it is medicine or baseball (well, maybe 1/2 the time spent training as a politician would make a better representative, but that’s the exception). If they spend more time with patients it is because they are under less expectation and less pressure for productivity, which can change. Knowing when a patient is “sick” or complicated rather than “just has a routine” something or other is easier said than done. That is where the breadth of medical training can help.
“The argument that patients’ health is put in jeopardy by nurse practitioners? There’s no evidence to support that,” said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health. There’s also no evidence that Mr. Needleman knows anything about clinical medicine or whether he uses a NP as his primary health practitioner.
MD in Philly (3d3f72) — 4/13/2010 @ 6:54 pmI am a nurse practitioner. The whole profession has done itself a disservice in the past several years. Many schools are admitting students into MSN/NP programs straight from their undergrad RN program without requiring any prior clinical experience. When I trained, it was the norm to have worked several years as an RN (perhaps even as an ICU nurse) prior to admission to an NP program. These days the freshly minted NPs have minimal to prior clinical experience. I would not want these newly minted NPs caring for me or a family member.
CardioNP (d18b93) — 4/13/2010 @ 8:25 pmThere’s been trouble getting MDs to into family practice and other “low prestige” (low pay for MDs) primary-care practice for well over a decade. Let them take their specialized training into specialized medicine.
NPs and PAs are ideally suited for routine matters (especially denying over-prescription of anti-biotics for viral infections like the flu or colds, against which they are utterly useless).
Banzel (b4a91b) — 4/13/2010 @ 8:58 pmThe health care industry has been getting more and more strange since I was a child. My primary care physician is a NP. Well, no, that’s not true. The clinic I go to has changed her supervising GP three or four times in the last decade. She’s seen me far more often than all of them together, listens to my questions, and answers most of them immediately. It has worked well, so far. It’s entirely possible that she was near the top of her class. What do you call the M.D. at the bottom of her class? Doctor.
htom (412a17) — 4/13/2010 @ 9:16 pmThe future is for NP and PAs doing primary care. My future in-laws were going to my ex-wife as their primary care doc as she was an NP. She used to call me if she had a difficult problem. The docs who were supposed to supervise her were always too busy. They loved her but never got a bad disease. Last year, my son’s mother-in-law got a serious blood condition but I got her into a specialty practice at Cedars by calling friends.
I have told my students that, if they want to go into primary care, to get an MBA. A number of them took the advice and the ones I have kept up with are satisfied. One of them, who is a friend on Facebook, is at an MD MBA convention this week.
They will supervise a number of NPs in a primary care clinic. For the general public, they will probably do OK since, as we used to say, if you hear hoofbeats, you don’t look out the window expecting to see zebras.
God help you if you have a zebra.
If you want personal care in the next two decades, you should join a concierge practice and pay $100 to $200 a month for MD care. They are all dropping out of Medicare and soon will drop Obamacare.
Canada bans such private care but private clinics are opening all over Canada. They are defying the law and the government has decided not to prosecute anyone, especially since the Canadian supreme court ruled that “a health plan is not medical care.”
Mike K (2cf494) — 4/13/2010 @ 9:33 pmTry not to be surprised I had warned you all about this a few weeks ago.
pitchforksntorches (888cb1) — 4/13/2010 @ 11:36 pmWell first of all, we can always add veterinarians to the human health industry–gotta find them somewhere.
But on a more serious note, I heard something yesterday that’s disturbing. Apparently the proportion of females to males in med school is increasing.Female med students said that the profession is becoming less attractive to all students. Doctors in future will have lower pay, less professional prestige (after all, you’ll be just another hack working for the federal gubmint). So men are dropping from the ranks of prospective med students. The profession remains attractive for women however because it is one where you can manage your hours, take time off to have kids etc. You won’t necessarily be able to do that in a private medical practice–but you can do it on the staff of an HMO or working in an emergency room, or working for the gubmint health service.
So the question remains–where are we going to get people willing to put in 11 years or more of hard work–pre med, med school, internship, residency–and then just have a gubmint job?
Mike Myers (3c9845) — 4/14/2010 @ 8:02 amMust I always remind you folks about features and bugs?
JD (0f9c01) — 4/14/2010 @ 8:25 am