Monday, August 3, 2009

Goodbye Doctor. Hello Nurse Practitioner

There aren't enough primary care doctors to support a national health "public option" sort of system. So get to know your nurse. You'll soon be seeing more of him or her...

This is actually an interesting idea. It's a way of getting around the doctor shortage problem and having lower paid people do diagnosis that doctors previously did. It's virtue is lower cost. Its drawbacks are:
  • It is hard to argue you would get better quality care overall. Even though doctors don't spend more than 5 or 10 minutes with their current patients, why should we believe NPs would do so? You would now get 5 minutes with an NP rather than a doctor.
  • It's also hard to believe that nurse practitioner's wouldn't eventually demand higher salaries given that their workload and responsibilities will dramatically increase. So in the long run the cost savings would thin out a bit.
  • Would have to be concerned with legal issues if lesser trained NPs prescribe medicine and have more errors relative to the doctors they're replacing. I've got to believe there will be some lawsuits involved with NPs recommending things that may be above what they know.
  • Are NPs currently doing nothing at a hospital? I assume NPs are busy and that they're not idle. So where is the new army of NPs going to come from to replace or takeover from doctors the influx of caseloads? Isn't this just a shortcut where the idea is to train people on a relatively easier track than the M.D. route?
  • Could lead to even more specialization for better doctors. If a doctor is now essentially doing the same thing as an NP or just an overseer for extreme cases the NP can't deal with, why would they get a massive pay boost from a hospital if NPs are doing most of the work? If a doctor is good, why would they put up with getting squeezed by a government payer who is looking to "save money" by paying them less?

Overall, we're now ratcheting down the visit a notch. But quality will be the same. What do doctors know anyhow? We should have done this years ago (assuming it was just this easy).

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