1) The WSJ writes that a significant portion of the public is reluctant to be treated by anyone other than a doctor.
My take: Some brush off the primary care shortage, saying that the demand will be picked up by NPs and PAs.
Wrong.
The fact that the majority of mid-levels practice proficient primary care is not the point. The public reluctance to be treated by anyone other than a physician is enough to kill off this “solution” to the primary care shortage.
As an aside, who’s to say that mid-levels even want to go into primary care? The latest studies I’ve read suggest that PAs are more inclined to enter surgical and medical sub-specialties instead.
2) The Canadian province of Quebec is contemplating charging patients a $25 co-pay for office visits.
My take: Cost-shifting to patients in a single-payer utopia Canada? Despite the adulation wonks shower on the Canadian system, it does not address the problem of rising health care costs. That is something every country is struggling with. I think even the wonks will admit that.
3) The primary care shortage is temporarily being alleviated by foreign-trained physicians.
My take: Relying on international medical graduates (IMGs) to solve our primary care woes is short-sighted and misguided. If IMGs had their druthers, they would rather be specialists in urban, academic medical centers.
I suspect that very few IMGs would stay in an underserved primary care practice for the long term, and would re-locate the first chance they get to a more “desirable” practice.
Call it a weak band-aid solution over a gaping wound of a problem.
Related posts:
- Can we rely on IMGs to help with the primary care shortage?
- Foreign medical graduates and mid-levels will provide the majority of tomorrow’s primary care
- IMGs: Get used to it
- My take: Mid-levels, PCP summit
- Mid-levels for primary care, but not for surgery?
- My take: Mid-levels, health consultants, blogging
- Do mid-levels want to take over primary care?
{ 9 comments }
If a US citizen finds a certain rural community undesirable, why would a Pakistani or Filipino or Asian Indian find the area any better?
In fact, they will often feel even less comfortable. Somebody from New York may feel like an outsider in a certain rural area. Somebody from Manila or New Delhi or Karachi even more so.
So yes, the IMG’s have a practice geographic pattern that matches US graduates, and their preference for specialty practice is greater than US graduates.
If you want physicians to practice in rural America, you admit medical students who are from those rural areas. Then you make it worthwhile for the doc to practice there. You certainly don’t pay them less, which is the current situation.
I’ve been a PA for 30 years. I have had only one or two patients refuse to see me for that entire time. I work at an Urgent Care on weekends and routinely see 30 patients a day, none of whom seems to be upset to see a PA. There are plenty of MDs/DOs in the community, but they are generally doing something more entertaining on a Sunday afternoon. Or, someone could pay quadruple (or more) what they pay me and see a boarded EM physician for their influenza, but fortunately they have the sense to not do that.
To the anonymous PA above, what you propose would work. The patient can make a choice of what to do with his own funds. Pay less for a PA (and be seen faster) or wait longer and pay more for a ER MD/DO. However, it doesn’t work that way, because they are making that decision with someone ELSE footing the bill. Given no financial incentive and no sacrifice out of their own pocket, the tendency is to say “I want all that I can get for free”.
Its true Kevin. Derm PAs make more money (~100K here in California) and more PAs and NPs are trying to get derm jobs.
Americans also think they need antibiotics scans for colds, but that doesn’t mean it’s the best use of resources.
Perhaps the customer oriented nature of American medicine needs to be clipped back. Not every ache or pain needs an MD, no matter how important the potential patient is.
My previous comment should have read “what you propose would work, IN A FREE MARKET WORLD”. This is yet another example of how, as Kevin has pointed out numerous times, the artificial non-free environment that medicine is today, contributes greatly to our present day mess.
This is interesting:
http://www.nationalpost.com/news/canada/Story.html?id=319808
Regarding IMG’s:
http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50511
And we thought they’d be satisfied with their “60 acres and a mule”….
Take a look at the ethical implications. Western exploitation continues in many different ways:
http://www.annfammed.org/cgi/content/full/5/6/486#T1
It’s so hard to find good, submissive help.
Considering MD/DO schools are opening in droves, and expanding (MD, anyway) per AAMC demands @ 30% above existing levels, I believe very soon that foreign med grads will be shoved out of the equation, and AMG’s will dominate primary care…because they wont have a choice to go elsewhere.
At that point, the DNP nurses who are crying for residencies will effectively be shut down. The ripple effect will trickle down to decreased enrollment in DNP, with massive closures as funding dries up. PA schools will become more competitive, and for the first time, we will see MD’s who can’t find residency slots.
We’ll see MD’s go into mid-level positions as a sort of “resume building” exercise. This will all be the death of nurse practioners, who often fancy themselves as doctors. PA’s and MD’s will rule the day, at least for a while.
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