Time to unleash nurse practitioners and physicians assistants?

Discussion in 'Too Hot for Swamp Gas' started by Row6, Aug 16, 2013.

  1. wgbgator
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    wgbgator Sub-optimal Poster Premium Member

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    I'm not really celebrating any state of affairs. What I am saying is that the logic of the market will take the work done by a general practicioner with 10-12 years of training, and disassemble it into seperate, discrete tasks that only require 1-2 years of training to do. That's how the market and Taylorist-capitalism reduces labor costs and increases productivity when there is a mass market. Its basically industrialization applied to medicine. General praticioners are more or less obsolete, people that invest 10-12 years in school and training are going to (and have been) specialize where their investent will reap greater returns.
  2. oldgator
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    "What I am saying is that the logic of the market will take the work done by a general practicioner with 10-12 years of training, and disassemble it into seperate, discrete tasks that only require 1-2 years of training to do. That's how the market and Taylorist-capitalism reduces labor costs and increases productivity when there is a mass market. Its basically industrialization applied to medicine."

    appears you and they may have little understanding regarding diagnosis and treatment of illnesses....

    When work regarding a patient's care is broken down into smaller tasks---there is still the requirement for some one or group of people to assess the outcomes of all the work done by those who each do a discrete task.
    ----And what I describe is what we basically have at present--- nurses doing direct patient care, XR techs doing XRays, lab doing lab studies, PT doing physical therapy with the patient, etc, etc. But to coordinate the patient care, tests, etc requires far more than 1-2 years of JUCO will provide. The MD role is to coordinate and diagnosis and deterine measures to be taken in treating the patient. That requires understanding of the entire scope of what is going on with the patient. There are some others already in health field in addition to doctors who diagnose patient(nurse practitioners and physician assts to a limited extent, Ultrasound techs only in regard to what the ultrasound study the sonographer performed, shows are some).

    I addition, a large part of what a MD charges in fees is in regard to their being the person with whom the 'buck stops' in regard to responsibility for mistakes, etc that occur during the course of patient care. MD's pay a large amount in malpractice. If nurse practitioners take on even more responsibility in regard to diagnosing and treating patients you can count on their malpractice insurance rate going up....with the nurse charging the patient more in order for the nurse to pay for higher malpractice insurance costs.
  3. sappanama
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    sappanama VIP Member

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    agree somewhat, where i think you are wrong is they (whoever you want to replace the doc with, and i do not agree that a GOOD primary care doc is in any way obsolete) will soon want to do more and more with less training. there is no example i know of, of a group being satisfied while trying to take away someone else's job, and saying this is enough, "i don't mind that they get to do surgery, deliver babies (oh wait) while i have to stay here in this office and see patients who are noncompliant with their healthcare", i just don't see np/pa's saying that, i think it is much more likely to see them saying "it's only a meniscus/ appendix/fibroid/cataract/biopsy/ etc..we can do it" and then if we have any problems we'll send those to the doc for salvage. they want to skim the cream and leave the curd for the docs, further eroding ability to make a living. docs have always gone to the er and seen crap we probably would rather not have to deal with, because we knew the cream was just around the corner, take that away and there really is less of a reason to put up with the crap, and the complaining, and the ridicule, and the liability.

    there is protectionism in all fields, more than in medicine. in panama city i need a permit to move a toilet 4 feet, or the sink in the kitchen to the other side of the room. i cant build a house for my neighbor though we both think i have the skills to do it because the building/plumbing/ electrical/framing/grading trades have lobbied for protection and their job. why should physicians be any different. the trades can charge me more after 5 pm, but i cannot charge them more for returning their tibia to appropriate alignment at 2 am when they drunkenly crash their motorcycle. what's up with that.
  4. g8trdoc
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    g8trdoc Premium Member

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    Good healthcare is the best thing we have going in this country because the best and brightest (at least for the most part) choose to sacrifice lots of time, money and energy to obtain a degree. We want them to be compensated well so they continue to choose these professions. Only the jealous think differently.
  5. gatordowneast
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    gatordowneast Well-Known Member

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    Administering flu shots, drawing blood, bandaging wounds are things PAs and Nurses can handle easily and do now. There are plenty more routine tasks docs do that can and are laid off to staff.

    There is a reason med school is difficult to gain admittance to and challenging when one is there. A lot to learn. Add 3-4 years of residency and a fellowship and you are going gray or losing hair when you begin practicing. Knowledge is key.

    ACA's premise of adding 30-50 M to the system (and I don't buy the argument that all 30-50 M are in the system anyway) with no additional docs and saving money while doing so, is idiotic at best and a bold faced lie to all involved, which is probable.
  6. OklahomaGator
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    If for no other reason then their malpractice insurance will go through the roof from what they are currently paying. You wonder why legal reform wasn't a part of the ACA?
  7. orangeblueorangeblue
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    orangeblueorangeblue Well-Known Member

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    My family has had some really, really bad experiences with NPs and PAs over the years so the very thread title makes me queasy.
  8. wgbgator
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    wgbgator Sub-optimal Poster Premium Member

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    Well, they are "obsolete" in the sense that a) their numbers are disappearing, and b) there is no financial incentive to take their place in the way the market has operated over the last 20 years or so. We may still desire a good primary doc (in the same way we may desire a good travel agent to plan a trip for us), but whether that translates into actual demand, that remains to be seen. If people are happy with the reduced costs, and the standard of care doesnt drop vastly, then it may simply be nostalgia.

    My guess is that if people don't want people with only x years of training doing more and more complicated tasks either a) the field will erect barriers, adjust & self-regulate to some degree, or b) the government will regulate in the event of the failure of (a).
  9. jsc28
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    Isn't this what CVS does with all their minute clinics? I think they can only handle 20-30 different things though.
  10. orangeblueorangeblue
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    orangeblueorangeblue Well-Known Member

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    Yes, basically the same things that PAs and NPs handle at the doctor's offices. I just don't think you get very qualified care even at that low level.
  11. Swampmaster
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    Swampmaster New Member

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    increase medical school enrollments by 50%, flood the market with thousands of new doctors---costs will go way down, very quickly.
  12. viningsgator
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    If a customer is fine getting minor medical matters handled by a PA or NP then what's the issue?

    Now if I make an appointment with a Doc and an insurer or Dr tries to peddle a PA or NP then we have a problem.
  13. OaktownGator
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    Distributing medical services to under qualified providers is no answer to containing costs. Provider service costs for most people over the vast majority of their life time are relatively trivial.

    If we want to contain costs we need to identify and go after heavy hitter segments in order. And the biggest hitter by far is end of life care.

    [​IMG]

    Whether we call them "death panels" or "quality of life panels" we need to get serious about letting people die comfortably with their families, instead of flushing millions of dollars down the toilet to keep people alive, in pain, for extra weeks or months.
  14. GatorBen
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    GatorBen Well-Known Member

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    As well it should, when you give someone the opportunity to make many more - and far more serious - mistakes, the cost of insurance against those mistakes should rise sharply.

    Because to a large degree it isn't actually the problem? It certainly is a driver of cost, but I would much rather have it out there to encourage "better safe than sorry medicine" than I would have a system that leaves doctors largely insulated from any real consequences to their own negligence. Add in the fact that you are going to allow more marginal practitioners into the field with greater responsibility, and you darn well better have a fully functioning tort system to either discourage mistakes or compensate the victims of them when they inevitably do happen.
  15. northgagator
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    I agree with your entire post.

    The last paragraph is very accurate too.

    I can add one more thought to it.

    As the liability of the nurse practioners increases so will their fees.
  16. sappanama
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    sappanama VIP Member

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    but reimbursement won't, guaranteed. none have for 20+ years.
  17. HallGator
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    I've been going to a PA for almost 15 years and have nothing but good things to say about him. When he thinks it is warranted he refers me to a doctor and I have a specialist for treatment of lungs problems I've had.
  18. tegator80
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    tegator80 Well-Known Member

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    I consider the use of non-doctor personnel for things that used to be their purview is in line with having midwives delivering babies and title insurance administrators doing the closings on land acquisitions. The system tries to save money on things that appear to run on auto-pilot. The question has to be, what happens when things don't turn out exactly as projected?

    The malpractice issue has to be in play in the future. I can't see any real saving in the future when their costs to provide service increases. I DO see this as a way to meet the demand for care with ACA in full operation when the traditional, competent doctors decide it just isn't worth it. As I have posted before, Obamacare is going to turn healthcare into the same model as a school system in a large city. The truly competent professionals are going to leave in disgust or they are going to be employed by some rich folks, probably in a gray market kind of arrangement.
  19. HallGator
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    I believe it would be a good idea to increase their use whether ACA was on the scene or not. Decreases the possibility of doctor shortages.
  20. tegator80
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    Right now the dental assistants are doing the yeoman's work for the dentists, which allows them to do the big stuff. The dentist usually just shows up to make sure that they followed proper procedures. There is a place for semi-professional people taking the mundane tasks away from the real pros. Perhaps that is where community security is also heading. Having armed neighborhood watch people isn't the answer and the budgets won't keep more - and better - police employed.

    But I digress, what matters is what happens when things don't go according to the projections. As long as that is addressed and recognized by everyone (including the lawyers) then I am okay with it.

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