1) Nurse practitioners are taking over primary care in the UK. Today, Dr. Crippen describes NP-focused clinics that promote provider access and short wait times.
My take: There are calls for using mid-levels as a means to solve the primary care crisis in the United States. Two problems with that. First, mid-levels aren’t stupid. They see the problems that are afflicting primary care, ranging from the bureaucracy and paperwork, emphasis on volume and quantity, and the lack of professional respect. Like medical students, surveys show physician assistants are increasingly shying away from primary care and entering medical and surgical sub-specialties. Who’s to say that mid-levels even want to take up the primary care slack? Why board a sinking ship?
Next, will patients accept having the majority of primary care handled by PAs and NPs? Yes, there are numerous anecdotes of appropriate care and patient satisfaction, but I have also experienced significant pushback when patients are “forced” to see a mid-level. Will provider access supersede the desire to see a physician? That unanswered question will go a long way in determining if the mid-level PCP movement will gain traction Stateside.
2) Boston mayor Tom Menino convenes a group of academic physicians to find ways to reduce waiting times for appointments and expand access to urgent-care services.
My take: What a joke. The academic setting is precisely the wrong place to start if you want solutions. Look no further than our leaders at the ACP and AMA who have done very little to save primary care. The ivory tower is shielded from the issues facing private practice, leading them to be out-of-touch with the majority of physicians in the country.
If you want solutions, reach out primarily to physicians in the community, and don’t get blinded from the high-powered titles of academic physicians.
