Regulation

Nursing Our Way Out of a Doctor Shortage

Why it's time to loosen the regulations on nurse practitioners

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Thanks to health care reform, millions of previously uninsured Americans will have policies enabling them to go to the doctor when necessary without financial fear. But it's a bit like giving everyone a plane ticket to fly tomorrow. If the planes are all full, you won't be going anywhere.

There are not a lot of doctors sitting in their offices like the Maytag repairman, playing solitaire, and wishing a patient would drop by. Most of them manage to stay plenty busy. Nor is there a tidal wave of young physicians about to roll in to quench this new thirst for medical care.

On the contrary. The Association of American Medical Colleges says that by 2025, the nation could be 150,000 doctors short of the number we need. Meanwhile, the number of med students entering primary care, the area of greatest need, is on the decline.

It's hard to quickly boost the supply of physicians, since the necessary training usually takes at least seven years beyond college. The result, as an AAMC official told The Wall Street Journal: "It will probably take 10 years to even make a dent into the number of doctors that we need out there."

That, of course, is assuming that the new health insurance system doesn't drive aspiring or existing doctors out of medicine, which is entirely possible. Regardless, there seems to be no doubt that it will get harder to find someone to treat you, it may cost more, and you'll spend two hours in the waiting room instead of one.

Or maybe not. What people with medical problems need is medical care, but you don't always need a physician to get treatment. You might also see a different sort of trained professional—say, a nurse practitioner, physician's assistant, nurse, or physical therapist.

Not every ailment demands Dr. McDreamy, any more than every car trip requires a Lexus. If you have a sore throat, earache, or runny nose, you probably don't absolutely require a board-certified internist to conduct an exam and dispense a remedy.

But it may not be up to you to decide who is suited to provide the care you want. Different states have different rules on what these clinicians may do. In many places, a nurse practitioner has to be under the supervision of a doctor. In others, she may not prescribe medicines or use the title "Dr." even if she has a doctorate (as many do).

Medicare typically reimburses nurse practitioners at a lower rate than physicians. In Chicago, an office visit that would bring $70 to a doctor is worth only $60 to a nurse practitioner.

But the need for more primary care is forcing a welcome reassessment of these policies. So 28 states are reportedly considering loosening the regulations for nurse practitioners, on the novel theory that any competent professional health care is better than none.

Private enterprise is already responding to what consumers want. Walgreens, for example, has established more than 700 retail health clinics staffed by nurses, nurse practitioners, and other non-doctor professionals. CVS has its own version. The number of these facilities is expected to soar in the next few years.

You might fear that this sort of treatment is inferior to what you'd get from your personal doctor. Your doctor might agree. The American Medical Association, reports the Associated Press, warns that "a doctor shortage is no reason to put nurses in charge and endanger patients."

But put your mind at ease. A 2000 study published in the Journal of the American Medical Association found that where nurse practitioners have full latitude to do their jobs, their patients did just as well as patients sent to physicians. Other research confirms that finding, while noting that retail clinics provide their services for far less money than doctors' offices and emergency rooms.

Obviously, if you wake up with crushing pain in your chest or fall out of a second-story window, you'd be well-advised to see a specialist. But for common ailments that are mainly a nuisance, a physician may be a superfluous luxury.

Obama's health care reform rests on the assumption that expanding access demands a bigger government role. But even its supporters should be able to see that sometimes, it helps to get the government out of the way.

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  1. Good Morning reason!

  2. Good night reason (from the west coast).

    1. Good night tkwelge!

  3. G’morning Suki!

  4. Didn’t the soviets turn medicine into a profession largely staffed by underpaid women?

    1. Johnny,

      They turned much of two continents into mostly underpaid people devoted to making the people at the top comfy.

  5. Where the hell is Marcus Welby when you need him.

  6. Not every ailment demands Dr. McDreamy, any more than every car trip requires a Lexus.

    Maybe Obamacare wants to require us to drive a Lexus, alright….a Lexus GS460!

    Thank you, thank you.

    1. Nah, they want everyone to drive a 6000SUX!

      1. Robocop FTW!

        1. I’d buy that for a dollar!

  7. BOO!

    YOU SUCK!

  8. What people with medical problems need is medical care, but you don’t always need a physician to get treatment. You might also see a different sort of trained professional?say, a nurse practitioner, physician’s assistant, nurse, or physical therapist.

    Science, Chapman, you almost got one right.

    Why in the fuck must I have someone licensed by the State provide my medical care? One of the easiest examples being flu shots. You could train a chimpanzee to give them in a few days. Why must I be forced to go to someone with several years of State controlled training to get something as simple as a shot?

    State regulation of who can do which medical procedure IS one of the greatest reasons for escalating costs. Changing the names under which government bureaucrats designate approved practitioners will do little to positively affect cost or supply.

    Here is a wacky idea. How about I pay any person I fucking choose to give me whichever treatments I desire?

    1. Yes, and when you have anaphalaxis from your flu shot, please ask the chimp to call 911 before your airway closes.

      1. Assuming he is allergic to egg albumin.

  9. Great idea…..loosen the standards.

  10. How about I pay any person I fucking choose to give me whichever treatments I desire?

    we cannot allow all our decisions to be made by fucking. jeezus, you’re as bad as congress.

    1. we cannot allow all our decisions to be made by fucking. jeezus, you’re as bad as congress.

      I think that it is an absolute fact that if we made our decisions by fucking it would be exponentially better than what congress does.

      1. I’ll fuck you for it.

  11. Yup, a lot of basic medical treatment could be quite competently be administered by one’s local Eagle Scouts.

    1. We can’t have that. The boy scouts are obviously and evil organization bent on brainwashing our youth with ideals such as morality, responsibility, faith, and good will.

      Maybe ACORN or some other organization ,reminiscent of Tammany Hall, could supply some community organizers to form a committee to investigate your need for said medical treatment and determine where you would be able to receive the treatment in the most expident fasion. Of course they would need to be paid, so your taxes might go up a bit, but it would all be worth it to get the same level of treatment you get now.

      1. +3

  12. You don’t need an automotive engineer to inspect your brakes and you don’t need a physician to diagnose that burning sensation when you piss.

    1. True enough in most cases. There’s a saying in medicine, “If you hear hoof beats, think horses, not zebras.” In most cases we have very routine problems. The only thing I worry about is the rare occasion when my problem is a zebra running me down. That’s when it would be nice to have a board certified physician on the job.

  13. Fair enough. NPs and other primary care providers will be necessary to fill the shortage of primary care doctors. But, you should’ve done a little more research before writing this article. The approaching shortage of NPs, PAs and RNs is as bad, if not worse, than that of primary care physicians (depending on how you measure it). This is a problem that existed (and one we were aware of) LONG before the health reform bill was even proposed. Even without Obamacare, our great nation would have been short primary care providers.

    One of the major reasons there is a shortage of primary care providers (MDs, NPs, PAs) is because economic incentives have been driving students in the health care fields toward higher-paid specialties for a long time. There was never a complementary movement to ensure that additional professionals be trained to meet the demand for primary care. The incentives luring health care students away from primary care are determined by (among other things) insurance reimbursement rates – which of course INCLUDES, but is NOT LIMITED TO, Medicare.

    Public AND private insurance have created the system that provides strong economic incentives for specialization. As a result, we have a primary care workforce that is overworked, understaffed and (relative to their nephrologist colleagues) underpaid. Providing more access to health insurance will likely exacerbate the effects of a PCP shortage. I would argue, though, that the answer should not be to deny those uninsured people coverage, but to create the right economic incentives to ensure an adequate supply and utilization of primary care providers. IF we have an adequate supply and IF people access that primary care, health care costs would likely decrease. Most of our health care dollars are spent on poorly managed chronic diseases – a role that is ideally suited to primary care providers.

    Let’s be honest with each other, though. This is not simply a function of Obama, the health reform bill or state regulation. This is, more broadly, a function of our decentralized, fragmented approach to delivering health care for our people. Government, private industry and the public at large are all to blame.

    1. Ken-

      Thanks for making the points I was going to, but in a much more eloquent way than I would have. My wife is a nurse, and is very concerned about the nursing shortage. Even if more schools are built, there is still a significant shortage of instructors.

    2. Letting more competing medical schools open, and getting rid of the government restrictions on the number of medical students might help just a little bit to fill the shortage. Also, stop throwing regulatory favors to the “specialists” and allow more liquidity in the kinds of services medical providers may offer. Fuck.

      1. We are not all trained to provide the same services. Many of the things which posters on here seem to think are so damn simple just aren’t. We are not talking about fixing your porch or something where if someone screws it up it just looks bad. If I make a mistake at work I easily can kill someone. Even with the best intentions….even if I think I know what I’m doing. Medicine attracts megalomaniacs. The type that think they know it all and can do it all too.

    3. This is, more broadly, a function of our decentralized, fragmented approach to delivering health care for our people. Government, private industry and the public at large are all to blame.

      I couldn’t disagree more.

      Help me out here, Ken. Can you name a single reason why the market, left to it’s own devices, can’t provide enough people? If not for the burden placed by government, why wouldn’t more people go into a business with guaranteed growth potential? It doesn’t pay enough? Why? It costs to much for the education? Why? Not enough nursing schools? Why? Because there isn’t enough profit. Why? Because of government.

      Of course insurance, both private and public, add to the problem, but private insurance in America is one of the most heavily regulated industries that there are.

      The combined wisdom of the market is the best system human beings can devise. Hundreds of millions acting in their self interest. Our current medical system is as broken as it is because of it’s distance from that combined wisdom and little, if anything, else.

      1. Marshall,

        I’ll give you a couple reasons why the market hasn’t and won’t solve all of our health care woes (though, I’ll admit, I’m not a “specialist” in health care economics):

        1) We Don’t Make All of Our Health Care Choices: Let’s say, for the sake of argument, that you’re buying a radio. You can educate yourself about the costs and the benefits of a particular piece of equipment. You might place some added value on the fact that it’s a HD radio, for instance, and you might be willing to pay more money for that. You wouldn’t pay someone to choose and purchase your radio for you.

        In health care, it works differently. Your provider is typically making the purchasing decisions for you. The reason docs go to school for so long is so they can learn how to evaluate the best treatment options available for a particular condition. Almost by definition, we (as consumers), are unable to assess the differences between particular drugs, technologies, or services. Therefore, we are never able to make fully-informed decisions about our own best financial best interests (in comparison to our physical/biological best interests) because we can rarely, if ever, know enough as our providers. In an ideal scenario, we would have sufficient knowledge about the medical options and their associated costs to assess what we are willing to pay for, based upon the expected benefits. And admittedly, patients need to be better educated about the health services they receive and they need to participate more in the health care decisions that affect them.

        The consequence of our “ignorance” is that we don’t apply the brakes when a particular cost might outweigh the benefit associated with it. There’s not the same sort of internal mechanism for controlling spending than with the radio example. This issue is exacerbated by the fact that we rarely (if ever) see how much our health care services actually cost. That’s left up to providers and insurance companies to deal with. The “true costs” of medical care are sort of hidden from view. And hardly anyone living in the states would be able to simply cut a check for their chemo or their knee surgery. So we sort of have to rely on the insurance model.

        2) Choice?: Many people don’t consider health care choices actual choices. You can live without a radio. You might not be able to live without an expensive heart transplant. So, the incentive for a given patient to undergo a given health care procedure is often more extreme than a typical consumer choice. Typically, a person would rather go bankrupt and/or shift a bunch of their costs onto society as a result of expensive medical care than die for not having received it.

        3) Demography: One of the reasons our shortage of providers will be particularly acute in the coming decades is because the baby boomer population is approaching retirement. They represent such a huge proportion of the workforce, and the population as a whole, that we won’t have enough people to replace them.

        This is not necessarily something that the market will be able to respond to with any speed or efficiency. As a matter of fact, the market IS responding to the demand for nurses. It just isn’t doing so quickly enough. New nursing professors are being trained, and schools are struggling to accommodate the overwhelming number of applicants they receive. Nursing students are being turned away because classes are already overbooked. But it takes time for people to earn PhDs in nursing (often a requirement made by the SCHOOL not the GOVERNMENT). It takes time to interview candidates. It takes time to administrate the additional enrollment of nurses. So, to a degree, the market is responding. But we’ll always be a step behind if we rely on the market alone. An alternative is to use the power of government to adjust the incentives in preparation for the coming workforce crisis. We can do so by providing incentives for students to go into nursing or primary care (e.g. govt assistance with student loans). In other words, we can use the govt to plan ahead while the hospitals and insurance companies (and even the professional schools) are trying to make ends meet in the short term.

        I trust that you have the best interests of our country at heart, but your series of questions and your conclusion that it’s all the government’s fault is pretty weak. I’d need to see a better reasoned argument (with some evidence that “not enough nursing schools” is the reason why an education in health care costs so much, for example) to even begin to understand your rationale. Are you suggesting, for instance, the expensive use of medical technologies and high drug costs don’t contribute to the cost of medical education?

        p.s. Just curious, do you work for the insurance industry?

        1. Just curious, do you work for the insurance industry?

          Obviously not. If I did, I would be praising the way that the benevolent bureaucrats were keeping costs artificially high through regulation and the government monopoly of medical licensing.

          Your points amount to “people are not smart enough (or don’t want) to make decisions, so there betters MUST make decisions for them.” Basically, “it isn’t the governments fault, but they are the only ones wise enough to make the decisions”

          Why can I not educate myself about medical decisions, just like radios or retirement plans? I am capable of choosing between different doctors, but not which one, unless they have a permission slip from government bureaucrats?

          Why? If I choose to go to Juan’s Quick Appendectomy, the only person who suffers if Juan does a poor job is me. My mommy died in ’91.

          I am not suggesting that I would hire a homeless person to do brain surgery. What I am suggesting is that I am every bit as qualified as any bureaucrat to determine which specialist to believe, or hire, and how much I think their service is worth.

          1. Let me amend my comment a bit.

            I am not sure that you are following me.

            For the sake of argument, let’s assume that your wife lost her license to nurse because of a criminal conviction. Would she be less educated or less able to do her job simply because the government had rescinded her permission slip? Of course not. So why did she need it in the first place? Because I am unqualified to judge her qualifications?

            You still have also not offered a reason that there is a shortage of nursing/medical schools. I say they can’t make a profit because of government regulation. You simply seem to be saying it is unknown and unfixable, cause we are all at fault.

            Since you asked me if I was in the insurance industry I will ask you a question.

            Is your “solution” to this “emergency” more government money, by any chance?

            1. I’d like to see a credible economic evaluation that indicates “government regulation” is the cause of high med/nursing/pa school tuition…

              I never said there was a shortage of med/nursing schools. Only that there is and will be a shortage of primary care providers. I think I laid out my argument explaining the shortage of pcp’s pretty clearly.

              I gave tuition reimbursement as an example of a way in which government can provide financial incentive for students to choose primary care. So, in a sense, yes. I am suggesting that federal money could help solve the doc/nurse shortage.

              I wouldn’t dream of suggesting that the government could solve the issue all on its own. But I think it would be wrong-headed to suggest that government is always “bad.”

            2. Of course you are unqualified. Tell me, how exactly is it that you know if your physician, or your nurse, is a good one? I’ve seen plenty of patients who swore up and down that their doctor was awesome even as I looked in the chart and saw absolutely boneheaded treatment decisions. Often it came down to if the doctor had a good personality or a nice looking office.

          2. You distorted my points.

            I never said that health care providers are fundamentally “better” than any one else – only that they are better at evaluating the costs and benefits of various medical procedures than people who haven’t gone through medical training.

            I didn’t say that people aren’t “smart” enough to learn about their health care options. I would say, though, that most people are uninformed or ignorant of the costs and benefits of various health care procedures. I fall into this boat, too, since I have zero medical training whatsoever.

            I never suggested that you couldn’t educate yourself about health care decisions. In fact, that’s exactly what I said people should do more often.

            I would argue, though, that the BEST way for people to learn how to evaluate health care decisions would be to go to medical school. That’s how doctors do it. But most of us don’t have the time, money, motivation or energy to go to medical school.

            I don’t know about you, but I have other things I’d rather do.

            1. I never suggested that you couldn’t educate yourself about health care decisions. In fact, that’s exactly what I said people should do more often.

              Hmm, seems to me you keep saying that an individual simply can’t, without those benevolent doctors making it for them. Which is it? Should people educate themselves or is it impossible without attending medical school?

              Thomas Sowell’s quote covers this, and most things, quite well. Chad simply hates it, since he WANTS others to tell him what to do.

              “There are many people who have above average knowledge who do not realize that they do not have one tenth of the knowledge of all of the average people combined. In this case, for the intelligentsia to impose their notions on ordinary people is the imposition of ignorance upon knowledge.”

              Tang?! You have got to be kidding me!

              Rest easy, Ken, your Mommie the State will continue to watch out for you.

              1. 1) The name of this website is “Reason” – not “Condescension.” If you are unable to form an argument without also making insulting comments, I won’t respond to your arguments anymore.

                2) Some health care decisions are best left to a trained medical professional. Other health care decisions should be made by informed, empowered patients.

                3) Was Thomas Sowell talking about the best way to conduct a heart transplant? Or manage diabetes? Or choose between different types of medication?

                4) Since you were unimpressed by the Tang example (incidentally, developed by NASA – a government agency), I’ll give you another. The national highway system is one more example of the government planning ahead effectively, meanwhile encouraging innovation and commerce. Once again, I’m not saying that those silly bureaucrats have all the answers to all problems. But there is a role for them.

                1. The name of this website is “Reason” – not “Condescension.” If you are unable to form an argument without also making insulting comments, I won’t respond to your arguments anymore.

                  You mean because your question about me being in the insurance industry was pertinent to your claims?

                  Was Thomas Sowell talking about the best way to conduct a heart transplant? Or manage diabetes? Or choose between different types of medication?

                  Of course he was. Are you claiming that all doctors agree on those issues? You continue to confuse the difference between being trained and having a government approved permission slip.

                  It isn’t a question of having your auto mechanic perform brain surgery, in spite of your straw men. It is a question of which professional YOU choose to hire, rather than having a list approved by government bureaucrats. People who, JUST LIKE YOU OR I, don’t have a PhD.

                  You claim there is a crisis but seem in denial about the obvious areas in which government contributes. Rather than increasing “incentives” at the cost of the taxpayer why not simply remove some dis-incentives?

          3. Why can I not educate myself about medical decisions, just like radios or retirement plans?

            You can, but odds are you’ll screw it up. For every patient I’ve seen that has a sensible perspective about disease, there are 20 who think they can be cure cancer with probiotics, and another 20 who want to cut out anything that itches. And if you actually give in to their stupid ass requests and deviate from standards of practice, they can sue you. This, as much as anything else, drives physicians into anesthesia.

            The whole point of hiring a physician is so that you don’t need to educate yourself in medicine. Specialization is the basis of civilization. You don’t have to learn medicine, I don’t have to understand how to make furniture.

            Why? If I choose to go to Juan’s Quick Appendectomy, the only person who suffers if Juan does a poor job is me.

            Well, I’ll give you a rundown of what happens next: your surviving family sues Juan, who couldn’t get insurance because he’s a hack, and he goes under.

            Even in a completely unlicensed system, practitioners would still be limited by who could get malpractice insurance at an affordable rate. Which is to say that the field would look no different than it does today.

            What I am suggesting is that I am every bit as qualified as any bureaucrat to determine which specialist to believe, or hire, and how much I think their service is worth.

            Bureaucrats don’t decide such things. Licensing is done by state medical boards, made up of doctors. But if it weren’t, the actuaries of the insurance company would be wielding the power instead with similar results.

            1. For every patient I’ve seen that has a sensible perspective about disease, there are 20 who think they can be cure cancer with probiotics, and another 20 who want to cut out anything that itches. And if you actually give in to their stupid ass requests and deviate from standards of practice, they can sue you

              This is true DBN.

              However, patients do have the right to either accept our opinion and TX regimens or not. As you know, this is where meticulous documentation is critical. You know as well as I do that patients have a bad habit of not following orders until a relatively minor condition gets worse requiring more agressive intervention.

              Part of our job is to provide care at the best of our ability and address patient concerns. Ultimately, as the consumer, they do have the right to dictate care, even if their dictates are contrary to accepted medical practice. The other side of that coin is we are not incumbent to put our licenses out on a limb just “Well, WebMD said…”

              That said, patients also need to realize that we are at liberty, with enough documentation of a HX of non-compliance to orders and therapeutic intervention, that the doctor/patient relationship can be severed (this does vary by state law of course). Patients also need to realize, as you said, that they are contracting with us for our services and expertise in whatever area it may be (general surgery here).

        2. An alternative is to use the power of government to adjust the incentives in preparation for the coming workforce crisis. We can do so by providing incentives for students to go into nursing or primary care (e.g. govt assistance with student loans). In other words, we can use the govt to plan ahead while the hospitals and insurance companies

          I missed this the first time.

          Absolutely absurd. The government only needs to come up with a “Five Year Plan”?

          How will the government know which incentives will motivate people? Through massive trial and error? No, through bureaucratic diktat. Can the government ever “plan ahead”? Other than planning on fleecing the stupid and that they will shortly be declaring another “emergency” that only they can fix, no.

          As for new technologies costing more, I am convinced. Just the other day I spent $1000 for a cell phone. Last week I paid $10,000 for a plasma TV. Oh, no I didn’t. Among it’s many other evils, government stifles innovation. Your cell phone costs today less than one ten years ago and performs 10 times better. Must have been a result of “government provided incentives”? Hahahahahahaha.

          1. 1) Once again, you distorted my point. I never said anything about a “Five Year Plan.” Not all government activity can be compared to communism.

            2) Money motivates people.

            3) I think the government did a pretty good job with Apollo 11. Government isn’t always (or even often) the answer, but they do okay sometimes.

            Even Medicare works out pretty well. There are a lot of older Americans who are very happy with their health insurance. Remember that old guy who said “Keep your government out of my Medicare?” He seemed to like it alright.

            4) Government doesn’t stifle innovation (at least not all the time). It actually supports and funds innovation – called “research.” Ever heard of duct tape or Tang? Government-subsidized innovation. The internet you’re using to rail against the government? Created by government.

            I’d be surprised if there was a drug that’s come out in the past fifteen years that wasn’t understood, at least in part, as a result of research funded by NIH (a federal agency).

            5) You missed my point about the technology. Medical technology is different than cell phones and tv’s. Everyone wants a cell phone. Not everyone wants or needs an MRI machine.

            Often times, there isn’t enough competition among medical device manufacturers to drive down costs. As a result, medical costs increase because the technology making it happen is very, very expensive.

            Good night, Marshall.

    4. One of the major reasons there is a shortage of primary care providers (MDs, NPs, PAs) is because economic incentives have been driving students in the health care fields toward higher-paid specialties for a long time.

      Agreed. It is time we quit overpaying our specialists.

      1. And suing them.

        1. This is a sticky one for me.

          I do see the need for redress of grievance provided that there is an actual case of malpractice or negligence, but overall, the system (read Med Mal attorneys) encourages too much frivolous lawsuits where the great majority, IMO stem from patient non-compliance or withholding medical information pertinent to the outcome of their case. Not to mention when the best outcome possible does not meet the unrealistic expectations of the patient, but well within accepted clinical outcome. Then an unscrupulous attorney convinces said patient that “You are owed money for your pain and suffering” and a case without merit based on little more than a punative vendetta because the patient is having difficulty accepting a given outcome.

          I am a huge fan of a “loser pays” system to discourage frivolous lawsuits. The general public also holds the erroneous view that all doctors are rich, fueling a vindictive attitude of “they can afford it.”

          1. “I am a huge fan of a “loser pays” system to discourage frivolous lawsuits. The general public also holds the erroneous view that all doctors are rich, fueling a vindictive attitude of “they can afford it.””

            I say allow the patient the option of cheaper medical service by waiving the right to sue except in cases of intentional harm, removing the cost of malpractice insurance.

  14. Get the latest on the health care reform at HealthOverHaul. Very good/short reads about everything healthcare

    http://www.healthoverhaul.wordpress.com

  15. I think letting more nurses etc have more authority is generally a good thing. Although, I do agree about not letting them go by “doctor” even if they have a doctorate. It’s confusing IMO.

    1. Words like lord, baron, count, sir, the twelfth, etc have no legal meaning in the United States and don’t grant anyone authority or privilege. “Doctor” should be treated the same way.


  16. The Council on Foreign Relations accuses the Tea Party and Glenn Beck of sedition!

    Read this article at the Freemen Institute by clicking on the link below:

    The Freemen Institute!

  17. We already have a major quality problem in medicine: At least one-fourth of physicians are unable to make correct diagnoses on more than 10% of their patients. This problem exists because of poor physician training and inadequate oversight by state medical boards.

    Physician assistants are less qualified than physicians to make diagnoses, and they can function independently only when dealing with common problems or known (pre-existing) conditions. Expanding their roles and their independence will lead to more misdiagnoses, incorrect treatments, and poor outcomes.

    Nurse practitioners are even less qualified than physician assistants to make diagnoses and devise treatment plans. Expanding their roles and independence from physician oversight will be disastrous.

    I’m a pathologist, and I’ve seen all kinds of medical screw-ups. At a VA hospital I worked at a few years ago, I know of two deaths caused by nurse practitioners working beyond their capabilities. I also fielded lab-related questions from NPs and PAs, and I was astonished at their ignorance. For example, one PA did not know that the condition called multiple myeloma was a form of cancer.

    Improving access to care by giving more independence to people less qualified that physicians will result in more mistakes, and every medical mistake results in more costs and more suffering for patients. To improve quality, we need to retrain or restrict the practices of mediocre physicians. To improve health care access, we need to better utilize our current PAs and NPs and encourage topnotch nurses, lab techs, respiratory therapists, pharmacists, etc. to train to become NPs, PA, or physicians. I know a number of persons that did this, and they all became good to excellent clinicians.

    1. To improve quality, we need to retrain or restrict the practices of mediocre physicians.

      Because nothing increases supply or cuts costs better than decreasing supply!?! It is simply

      To bad they don’t (apparently) even teach economics 101 while earning a PhD. Clearly Dr. T doesn’t know shit about supply and demand. Sure, medical costs keep increasing because the government doesn’t restrict the practice enough!

      We are well and truly fucked.

      1. Yes, it disagrees with the laws of supply and demand, but my personal feelings are that we need to do away with general practitioners making diagnoses, and encourage people to go to specialists… with no limit as to the number of people that can train in a certain area. This way we’d get high levels of knowledge and care in a specific area, that follows market demand… more people would train in an area that has a higher demand for patients.

        I’ve been misdiagnosed by PAs and general practitioners enough, with issues only to be immediately recognized and solved by specialists, that I don’t trust anything general doctors say, I just ask for a referral to a specialist. When I had a PPO plan, I never saw one PCP, I only went to specialists with a specific problem.

      2. That word “quality” can be a difficult one to understand.

    2. “We already have a major quality problem in medicine: At least one-fourth of physicians are unable to make correct diagnoses on more than 10% of their patients.”

      Cite a link, please.

    3. “Improving access to care by giving more independence to people less qualified that physicians will result in more mistakes, and every medical mistake results in more costs and more suffering for patients. To improve quality, we need to retrain or restrict the practices of mediocre physicians.”

      But only within voluntary associations of practitioners guarding their association’s standards, having scrapped government licensing of medicine.

      Meanwhile, specialty stores will provide cheaper and better superficial wound stitching at much cheaper prices, 24/7.

  18. That, of course, is assuming that the new health insurance system doesn’t drive aspiring or existing doctors out of medicine

    To where? Virtually all the alternative careers have been hit hard in this recession. Doctors have largely been untouched.

    1. No offense, Chad, but I’m a doctor, and you don’t know what the hell you’re talking about.

      1. Same here, and I’ve argued with him about it before.

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  21. Allow medical acts between consenting adults: scrap government licensing.

    I might want a wound stitched up by a seamstress, fisherman, or veterinarian. Let me do that legally.

    Dan Blachly

  22. children… it is comments like these that make the public feel that unions are necessary. Everyone is so afraid the world is out to get them. Or that it is out to suppress their opinion… breeeeathe.

    Dennis
    http://newyorknurse.net

  23. Obama’s health care reform rests on the assumption that expanding access demands a bigger government role. But even its supporters should be able to see that sometimes, it helps to get the government out of the way.

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