Posted on 01/14/2020 5:59:33 AM PST by Kaslin
President Trump recently issued an Executive Order protecting and improving Medicare for our nation’s seniors. The October 3, 2019 order was intended to increase Medicare beneficiaries’ access to primary care. The executive order is little more than a policy goal at this point. Item five of the executive order annoyed physicians. It gave the Secretary of Health and Human Services (HHS) 12 months to formulate a proposal to expand the autonomy of nurse practitioners (NPs) and physician assistants (PAs) working in the Medicare program. Under the proposal, so-called midlevel providers would be allowed to practice with far less supervision, prescribe medications and bill Medicare when they see Medicare patients. The proposal also seeks to equalize compensation paid to physicians and PAs/NPs treating Medicare patients.
NPs and PAs have been fighting for greater autonomy for decades. However, the proposal has some powerful enemies: doctors. This is how it currently works: in virtually all states doctors are responsible for the care provided by NP/PAs. Some states require NPs/PAs to have collaboration agreements with physicians. Yet, not all physicians want to collaborate with NPs/PAs and those who do naturally demand a portion of the revenue and often place restrictions on what tasks NPs/PAs can perform. Many other states require a form of direct supervision, often requiring a percentage of patient case files be reviewed by the supervising physician. Thirty-nine states even place limits on the number of NP/PAs any one doctor can supervise.
This turf war, known as scope of practice, is raging not just on Capitol Hill but also in state legislatures all across the country. It is easy to see why physicians oppose greater autonomy for midlevel providers. Recall I said that doctors currently must supervise midlevel providers in virtually all states. Thus, most NPs and PAs either work for doctors or work with doctors and give them a cut of their pay. Under President Trump’s initiative, physicians would lose some of their ability to profit off NPs/PAs' work. More galling is the fact that physicians have much more rigorous training requirements, higher student loan balances yet may be paid the same for a 20-minute office visit with a senior. With this executive order President Trump seeks to turn NPs/PAs into primary care physicians’ competitors rather than employees and collaborators.
Why allow seniors to make appointments with nurse practitioners and physician assistants independent of doctors? Because the vast majority of medical conditions that patients experience are simple problems that don’t require a doctor to diagnose or treat. More complicated conditions are easily referred to specialists. General practitioners participating in Medicare already do this. Furthermore, numerous surveys have found NPs have high satisfaction ratings and are rated as better listeners than physicians. Indeed, various surveys have found physicians tend to interrupt their patients with seconds after patients begin describing symptoms. More to the point, 78 million Baby Boomers will become eligible for Medicare by 2030 and many will be unable to find a primary care provider unless the supply is expanded. The Association of American Medical Colleges predicts a shortage of nearly 122,000 physicians by 2032.
Non-seniors should care about turf battles in Medicare because what Medicare does affects other areas of medicine. Current regulations that govern the practice of medicine are exclusive. Stated another way, state and federal regulations purposely create barriers to entry, making it more difficult to practice medicine and inhibits competition. In his book Capitalism and Freedom, Nobel laureate Milton Friedman described the American Medical Association as the “strongest trade union in the United States.” Trade unions reduce competition, not promote it. Cartels and professional guilds are never pro consumer. They exist primarily to boost the wages of guild members.
Whether in rural areas or urban areas, Medicare or private health plans, patients should have the choice and convenience to decide who they want to see. Patients should be free to see a nurse practitioner, a physician assistant, a primary care doctor or a physician specialist depending on their needs. When doctors argue all other medical staff should report to physicians in the name of patient safety, keep in mind the safety they are most concerned about is the safety of their income stream.
My Hematologist told me that some of her patients know more about their disease than she does. They have the time to read the research papers, and keep up with stuff.
Would they rather have Hillarycare, where a government bureaucrat would decree that their office will be in Dodge City, Kansas and they would earn a salary of $85,000 per year?
Years ago I took a kid to one of those drug store clinics. We thought she had strep throat. The NP on duty did a swab and said she wanted to be sure it was strep before prescribing an antibiotic.
The next day the kid’s throat was really sore. The wife got concerned and insisted we take her to the ER. They wrote her a scrip for antibiotics.
Next day the NP from the clinic called with the test results. Negative for strep. The antibiotics were useless.
Nurse Practitioner 1
Doctor at major hospital 0
Then retire already.
Doctors treat symptoms.
Healthcare success is in prevention.
Doctors are inept at prevention, because prevention is largely behavioral. Doctors, like the general public also, are poor at understanding behavior.
Which is why Doctors take the easy path of pill pushers.
Redirect Medicare towards prevention and let the ol’ Docs retire.
L8R.
Unfortunately the mainstream medical profession, rightly or wrongly, is perceived to be mainly drug pushers for big pharma writing prescriptions instead of looking at root causes.
Diabetes and hemochromatosis come to mind.
For rural areas, a good combination might be to have a NP or PA on site, with video teleconferencing capability to doctors as needed.
Maybe even video the exam, and have it reviewed at leisure by an MD — in India.
H-1B doctors are going to replace the US doctor/medical work force in the future. You can count on it. It’s all about cheap labor and bigger and bigger profits. You docs better form a union pronto.
Which by itself proves nothing about the percentage of cases in which PAs and NPs make messes.
I have an 8k insurance deductible
Anything I am having problem with I go straight to the internet and google.
95% of the time I am right an do self treatment or follow the instructions on how to treat.
I still have a physical every other year and only thing I am being treated for is mild HBP
So government should protect us from ourselves?
DU is that way.
Yep. Doctors are critical for health care preventive services.
You need doctors to tell you to maintain a good body weight and not to eat too much.
You need doctors to tell you to get some exercise.
You need doctors to tell you to get a good night’s sleep.
You need doctors to tell you to dial back on the “substances”.
Of course, you need doctors to inquire about firearm ownership and usage, don’t you?
Evidently many of you need doctors to tell you how to wipe your ass after a bowel movement and how many sheet of toilet paper you need for the job.
Or you could get your granny to tell you the some thing. It would be a lot cheaper.
Yep. Doesn't it take the knowledge and experience of an MD to recognize a combination of symptoms that could be serious? You don't get that with a 2 year degree.
AI technology is on the verge of offering real help here.
Also, I assume that when technician level people (PAs, NPs) get it wrong, they will be responsible. What will THAT malpractice insurance cost?
I’ve been going to an NP for years.
She has always done well by me. Straightforward and to the point with medical stuff.
There are a few doctors in the building so getting a 2nd opinion isn’t too much trouble.
I have mixed feelings on this. On one hand, independent practice for midlevels will remove the supervisory liability that MDs currently have. Obamacare forced MDs to join large hospital groups, in which they were told part of their job is to supervise midlevels. In my husbands practice, the malpractice lawsuits that did occur in his large group was error by midlevels and the supervisory MD (who had never even seen the patient), also got sued.
However, this will make healthcare worse because midlevels don’t know what they don’t know, and patients will suffer.
Both PA and to a greater extent, NP, rely on MDs for their training after their schooling. MDs need to stop that. If they want to independantly practice, then they shouldn’t rely on MDs to train them.
My wife must take medication for the same condition. She had to swallow radioactive iodine to zap her thyroid several years ago, so as you wrote, the pills go down the hatch for the rest of her life. But the dosage might need to be adjusted from time to time so that’s my understanding of why the periodic review by a doctor.
That being said, in the near future I think lesser trained personnel operating computerized diagnostic equipment, or even personal devices like Fitbit wrist bands, are going to replace the functions of most doctors. It seems to me they mostly diagnose flu, and colds, and the like. Things that are not life threatening. I think in the future you’ll only see a doctor when the app says you need specialized care.
so far it goes on my malpractice insurance.....
A lot of disease is a result of obesity. The only way Medicare could pay for prevention is to wire patients mouth shut. That would work.
You’re right!
And its really the only way that universal healthcare could even have a ghost of a chance of working. The government control your intake and your activities. (Actually it would only slow down its rising costs & bankruptcy since all are bodies will get old slow down its responses to disease, etc. and we will die. It can’t be turned into a zero sum game! So universal healthcare will never work!)
Agree. When I go to the doctor I want to see a doctor.
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