A proposed solution to the primary care shortage is that mid-level providers like nurse practitioners or physician assistants will “take over” primary care as doctors exit the field.
Voila. Costs cut, problem solved.
But it assumes that these providers want to enter primary care in the first place.
Dr. Val interviews a few nurses and finds that’s far from the case:
The only problem with this reasoning is that nurses may not be willing to provide primary care services for the same reasons that physicians aren’t too keen on it: the pay is low, the workload is grueling, and there are other career options that offer better lifestyle and salary benefits.I spoke with a group of nurses on a recent podcast about this very issue and their view was that, “we’re not suckers.”
As long as the incentives remain in place that favor specialists – higher pay and better hours – NPs and PAs will also gravitate away from generalist fields.
topics: nurse practitioner, physician assistant
Related posts:
- Mid-levels for primary care, but not for surgery?
- Why nurse practitioners and physician assistants will not solve the primary care shortage
- What role should nurse practitioners play in primary care?
- Foreign medical graduates and mid-levels will provide the majority of tomorrow’s primary care
- How the primary care doctor shortage threatens Obama’s health reform plan
- The public devalues primary care
- Primary care as a loss leader
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In relative terms physicians assistants and nurse practitioner are still the best set up to fill primary care needs. Yes its hard for someone to go back to school for a couple years and pay tuition of $100,000. But compare that to physician who are accumulating $350,000 of medical school debt and take 8 years to train for the same job. Most doctors have little to no work experience and often have 4-5 years of undergraduate debt and living expenses. Where NPs often have several years work experience earning good money and may have savings to pay for NP training. Physicians may also be bearing additional $10-100k debt in the form of small business loans for office equipment and practice overhead before they start to earn any real money. PA/NPs are most often salaried out school and bear little to no administrative burden. Bottom line, when you look at the larger financial picture it can take decades for a doctor to reach the same wealth level as a NP/PA for the same work. PA/NP do have a relative financial advantage for them to assume the primary care role.
Why must this always be an either or situation?
re: “higher pay and better hours”
Most specialists think PCP’s should be payed more but believe it or not not all subspecialists are rolling in dough. Talk with you local ID doc or rheum. CMS a few years ago stopped the markup for oncologists on their drugs (which I don’t agree with ethically) but did they make up for it any way? No. Talk with your consultant oncologist Dr. Val/Kevin, their practice’s are often crashing into the red. The global fee for general surgeons on their procedures such as chole’s is a friggen joke. About hours, believe or not guys your tyical surgeon/medical subspecialist puts in a hell of a lot of hours. IMO usually more than PCP’s. We are not talking lifestyle fields here.
Most general surgeons and many medical subspecialists also spent 2-5 more years on in training at indentured servants wages. I agree we need to get away from paying for procedures and more for time. But a bigger issue is the health care pie is not going to grow in size. What we should be talking about is reasonable expectations in care. Maybe we shouldn’t abuse people in the ICU to prolong their deathes. Maybe 90 year old’s with comorbidities shouldn’t get CABG’s of dialysis. Maybe we shouldn’t give 5th line chemo in a terminal situtaton. But in all honesty these are not just MD discussions, these are SOCIETY discussions. IMO Americans have shown no interstr in having these honest discussions (see the absence in the latest election). We want everything an we want it now…or we will call a lawyer. Until American society realizes that more isn’t better and healthcare is not limitless for all nothing will change.
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