"We Don't Need More Doctors" Article

[PRodulous]

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http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html?eref=rss_topstories

So I read this article/commentary and would like it share it with everyone. I can see arguments for both increasing the number of physicians and passing legislature to allow alternative methods to health care. Do you think the author's on the ball? What about using point of care diagnostics to alleviate the need to send a patient to a specialist? What do you guys think?

 

[coldweatherblue]

Rather than calling for more doctors, which would have been difficult for the government to impact anyway, what the country really needs are policies that pave the way to more avenues of care, which is well within the government's control.

mmmmmmm... the end of medicine draws nigh. lol

 

[Darksmurf]

In principle I am not opposed to turning over much of routine algorithmic primary care to NPs and PAs. Indeed, in the outpatient practices that I've seen, the nurses are the ones who pretty much do everything (immunizations, EKGs, spirometry, blood draws, rapid strep, cold agglutinin) anyway. Primary care physicians could become managers of a certain number of "mid-level providers" and could field any problems that the NPs and PAs don't feel comfortable with. This might be able to avert some of the coverage without access problems that a universal system will create in this country.

Two of the points of the article that I am less comfortable with are: 1) Expert systems software can guide generalists through the same decision-making steps that a specialist would take, and 2) TeleMedicine.

1) As much as we would like to make the complicated aspects of medicine a science, it most certainly is not. It's still an art and always will be. Even the scientific seemingly objective parts of medicine (lab tests, radiographs) are fraught with assumptions and other baggage that complicate interpretation and defy a simple flowchart. Medical knowledge only continues to expand, making specialists more and more necessary to give the best, most up-to-date care. So having my internist follow a flowchart to deal with my rheumatoid arthritis does not sound comfortable.

2) If you don't touch, hear, see, and smell the patient, you cannot provide the best possible care. Can TeleMedicine be utilized in areas that are truly rural and hard-up to get a doctor to travel out there? Sure. Is it a model for healthcare delivery generally? No.

And the article seems to insinuate that fewer doctor salaries will keep healthcare costs down. Apparently they are not informed that salaries have not kept pace with inflation even as cost have outstripped inflation. The third-party payers, the new-fangled devices, the branded drugs, and over-the-top whatever it takes to keep you alive for another few hours medicine is where the money goes in our system.

DS

 

[HPSPpayissues]

Although I don't agree that it is good for this society, it is definitely good for those who are going to be docs, since the law of supply and demand implies that we will make more money 😉

 

[FutureDoc4]

I just skimmed the article... but happens to make some valid points about cost effectiveness.....but the true yard stick for me is always ... would I allow this system to work on my father/mother/child.... my answer of course is no....

Especially with comments like this:
There is new technology that makes it easier for non-anesthesiologists to administer conscious sedation, for example, allowing procedures such as colonoscopies to be done under the supervision of just the endoscopist and a nursing team. By removing anesthesiologists from the equation, these procedures can be performed in a clinic setting rather than in hospitals.

Do you really want to be go under conscious sedation that is not given/monitored by an anesthesiologist? I mean, of course this is cost effective. But, is it safe? I don't have an answer. Maybe, it is.

However, for my family and I, I would want it administered by the specialist. I think there many valid ideas to cut costs in the article; however, many of them fail the "would I let this happen to my family member" yardstick test.

 

[WellWornLad]

You could make a similar argument for airplane pilots. I mean, come on, those things are on autopilot 95% of the time anyway...

The lawyer side of me is wondering who gets sued when doctors aren't part of the process.

 

[Mattabet]

The lawyer side of me is wondering who gets sued when doctors aren't part of the process.

That's an interesting point. It may be lawyers that save doctors here. There are going to be a lot of grey areas where nurses and techs perform pretty well, but doctors perform slightly better. In this litigious society, that 'slightly better' may translate to a corporation protecting itself from millions of dollars of settlement money and a much smaller liability profile by using docs.

 

[OncoCaP]

PA & NP clinics will probably become more important with time. We will likely see physician's clinics become more efficient as well. The author has an interesting idea, but the article raises more questions than it answers. I also wonder to what extent this author is selling his company's consulting services. I wonder about issues such as ... how is the patient supposed to know whether they have something minor or complex? Will PA's and NP's attempt to diagnose and treat conditions that are beyond their training and experience? I saw a patient in the EC not long ago who had a very serious issue that will likely lead to life-long disability because they presented too late. The PA at the Patient's PCP thought the patient had carpal tunnel syndrome even though the symptoms did not match very well with that condition. Had the patient been diagnosed appropriately initially, there would have been a reasonable chance of a more normal life. It is clear to me that we have room for improvement in medical care. My own sense is that as we apply technology more effectively and become less dependent on unreliable and somewhat inaccessible diagnostic techniques, medical care will improve. I imagine there will be a time when we will have sensors in our body that will monitor key parameters of our heath continuously and alert us in a manner similar to what we see on a car's dashboard, and going to the doctor's office might be a more high-tech experience as well. Until then, we have a labor intensive interview and physical examination process that was built on assumptions of work load and reimbursement that no longer apply and physicans are getting squeezed from all directions. In my mind it's not really a question of doctors versus nurses ... more a question of how do we diagnose and treat patients today and how can we improve the process no matter who is providing the labor.