Posted on 03/14/2020 9:23:20 AM PDT by Kaslin
If it seems like nurse practitioners are taking care of patients more often, this is not a mere perception. This is reality. And this is not due to coronavirus overwhelming the health care system. This has been happening for years. In February, Health Affairs reported the number of nurse practitioners (NPs) more than doubled from 2010 to 2017.
In today’s health care system—where it can take weeks to see a doctor—this is welcome news, unless you’re a physician. Physicians worry NPs will put them out of business and their concern is not far-fetched.
In Chicago, 15 physicians at suburban immediate care clinics were notified by their employer they will be out of a job on April 1. Their employer, Edwards-Elmhurst Hospital Health System, told the doctors they were being replaced by NPs. The hospital said the move would save $1 million over five years. Why is that even necessary, the doctors wonder, when the clinics seemed to have a steady stream of patients?
Welcome to the zero-sum game of the U.S. health care payment system, where third-party payers call the shots. In today’s health care system, the law of supply and demand no longer applies. Instead, health care systems simply take money from one pot of revenue and use it to shore up others.
Perhaps the hospital thought immediate care centers would be a less visible place to save money. After all, they are, by definition, drop-in clinics. Patients don’t expect to see the same practitioner when they return at some point in the future, so replacing doctors with NPs carries little risk of losing customers.
One reason for the budget gymnastics is the crazy nature of our third-party payment system. Public payers with a limited pool of funds like Medicaid and Medicare dictate how much they will pay for care. Due to this partial reimbursement scheme, providers must make up for it in one of two ways: They can charge people with private health insurance more (and they do) or they can hire less-expensive practitioners and hope consumers don’t notice. In many cases, they do both.
Obviously, it doesn’t have to be this way. In a free-market health care system, there would be plenty of room for both physicians and mid-level providers. Consumers in other walks of life choose whether they want to spend more or less for varying degrees of quality, experience, etc. all the time. Why not simply let the consumers decide?
The third-party payment system has distorted prices so much that patients typically don’t make these value judgements. Health care prices and service options are often imposed on patients by insurance companies, health care facilities, and, worst of all, government mandates.
Fortunately, there are many solutions to these problems. One such solution is direct primary care (DPC), a practice model not subject to the demands of third-party payers. Under DPC, consumers pay as little as $80 per month to see a primary care physician. In many cases, they also receive a package of other services, medical tests, and health care discounts.
DPC, which still isn’t permitted in many parts of the country, significantly slashes health care costs by cutting out the health insurance middlemen from unnecessarily being involved in the patient-doctor relationship. With DPC in place, patients are more likely to shop around for the best deal and for the arrangement that makes the most sense for their unique health care needs.
So, if a patient wants to pay a little extra to see a doctor instead of an NP, he or she could. If a patient would rather save a little money and isn’t suffering from serious ailments, the patient could see a more affordable NP.
By getting third-party payers out of the system (except for the costliest procedures), a real health care marketplace would develop in the United States for the first time in more than a half-century, unleashing the same kind of innovation and efficiencies consumers enjoy in many other marketplaces.
It is time for policymakers to let the magic of open markets work for health care. Americans have been languishing under the current model for long enough.
It’s been over 20 years since I’ve received treatment from a doctor.
I’ve never received treatment from a nurse practitioner or physician assistant.
Florida Governor just signed a Nurse Practicioner / PA Bill expand8ngntheir ability to treat.
I totally agree; let the consumers decide what level of service to do; I also see a future where cash price is listed vs medical-insurance-filed price.
My daughter is a family practice NP. She is very good at what she does. She knows when she doesn’t know something. She’s not trying to be a doc. She works with her physician that runs the practice. Firtherural community she lives in this gives many people access to health care that otherwise couldn’t be given
There is nothing wrong with advanced practice nurses. They can and do provide great care in a collegial way
Docs aren’t always so happy with the idea. Just like some docs don’t like osteopaths
There should be more like her. My compliments.
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Singapore has been doing it for years, great health care.
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NPs there can do everything up to setting broken bones, writing prescriptions, making referrals, etc.
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Far cheaper, immediate care, and they hand off to specialists.
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Just got get by the AMA lobbyists.....
I seldom go to a doctor for fear he might treat me for something.
“There is nothing wrong with advanced practice nurses. They can and do provide great care in a collegial way
Docs aren’t always so happy with the idea. Just like some docs don’t like osteopaths”
As someone who has used more than my share of medical services over the last six years (due to serious medical conditions) and who makes it a practice to visit the top medical centers in the country for my rare conditions, I can tell you that a) medically trained clinicians are God’s gift to humanity and b) that includes nurses, NP’s and PA’s. While they are not all created equal, most of them are very capable, smart and dedicated people. They’ve kept me going for many years. I am forever grateful. Without them and their knowledge and the institutions behind them, I would be toast! We’ve got the best medical system in the world.
Many major health care providers stopped hiring NPN’s last decade after their unions had demanded the same pay as boarded MDs.
You’re gonna die.
(Of course, we’re all gonna die.)
Fine. They are welcome to treat but under their own license and liability insurance not mine. And I’m not cleaning up the mess afterwards
The problem with NPs and PAs is that they don’t know what they don’t know. I know this from personal experience.
Nevertheless, they should be held to the same level of legal liability as physicians.
If so, I would expect that their insurance premiums will be very large, almost crippling.
Most ARNPs know as much about medical options in 2020 as MDs did back in the day when the doc came to your home with a medicine bag. They can handle anything that isn’t serious, and lots of things that are. And BSNs can handle lots of “usual” illnesses and/or injuries in pharmacy clinics. Set them free.
I stopped seeing male doctors because they don’t listen to the patient.
I stopped seeing female doctors because they don’t read the chart.
I will only see female NPs and PAs because they LISTEN to me, and they READ my f’n chart.
She lives what she does. She lives her patients. And the best part is she is a very good diagnostician
Last line is exactly correct
Well said
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