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Apr 20

“Brilliant” Solution To Worsening Physician Shortage As A Consequence of Obamacare: Creating Nurse “Doctors”

Fresh and ongoing from it initiating, feeding and perpetuating the housing debacle and collapse, the Federal government with its pernicious Obamacare is poised to destroy medicine and medical care as we know it here in the United States. If allowed to take root, gone will be the world’s best and most sophisticated healthcare system, home of most of the most important innovations and discoveries in medical care. In its place will be a near 3rd world level of “quality” of care encumbered by an oppressive and arcane government controlled system. At least in third world countries they don’t have swarms of attorneys pullulating like flies looking for their next jackpot.

It is commonly known that there will be a significant shortage of primary care physicians in the future which Obamacare will tremendously exacerbate for myriad reasons. Of course, neither Obama or Congressional Democrats considered this in their reckless haste to ram the healthcare reform legislation into effect. What a surprise – politicians didn’t anticipate something inherently important?

The end result? You will have the “right” of healthcare but you may not have a doctor to provide it to you. If you are ultimately able to schedule an appointment to see a doctor, you may have to wait an excessively long period of time to finally be seen, or be seen by a physician located far from where you live or work, or be herded through like cattle spending little time with the doctor who is massively overworked and overloaded with patients (and over-regulated).

Does the word “rationing” ring a bell? Or decreased quality of care? These were all important issues that were raised by those who opposed the Democrats’ plans but were ignored or denigrated by them and the press.

What is a “brilliant” solution for this problem that is being considered by the government? Have nurses act like doctors. Add a little more training, change some statutes and voila! Doctorlight. Easy! Just don’t be very sick or you might not make it to a real doctor.

And if the nurse gets a PhD, they can officially be addressed as Dr., adding to confusion but subtracting from quality. This proposal would place millions of Americans at unnecessary risk due to inferior training and as a consequence, inferior care.

Furthermore, given the government’s plan to reimburse these nurses the same or marginally less than real doctors, why would any sane person want to become a doctor? After all, for maybe $5 to $10 more per patient that a doctor would be reimbursed versus a nurse, that person would also have to go to medical school and residency for up to 11 or more years, assume debt to pay for school of $250,000 or more and then pay malpractice rates in practice that can exceed $100,000/ year.

This will surely dissuade many including the best and brightest from seeking a career in medicine and don’t we want our doctors to be smart and competent?

Sounds like another government plan causing unintended consequences.

Doctor shortage? 28 states may expand nurses' role
By Carla K. Johnson (AP) – 4/15/2010

CHICAGO — A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.

States regulate nurse practitioners and laws vary on what they are permitted to do:
_ In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.
_ In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.
_ In Montana, nurse practitioners don't need a doctor involved with their practice in any way.
_ Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.
_ In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.

The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.

Many with the title use it with pride.

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.

What's the evidence on the quality of care given by nurse practitioners?

The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.

"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.

Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.

The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.

One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.

Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.

That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.

But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.

The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.

"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.

The new U.S. health care law expands the role of nurses with:
_ $50 million to nurse-managed health clinics that offer primary care to low-income patients.
_ $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.
_ 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
_ A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.

"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone."

In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.

She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.

Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.

"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."

http://www.google.com/hostednews/ap/article/ALeqM5jCB6VTbMN12zQSwafnZfBJovMseAD9F2CK880

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