Many health policy experts are saying that mid-level providers can help with the primary care physician shortage, which would also implicitly drive physician salaries down as PAs and NPs are paid less.
I’ve always been dubious of that assertion, mainly because they see the same bureaucratic morass that impedes primary care and subsequently, will cause them to gravitate towards specialty medicine as well.
The ACPs Bob Doherty backs that up with some numbers showing that almost half of PAs and NPs already work in specialty practices. Expect that number to only rise.
Furthermore, the number of mid-level providers is nowhere near high enough to meet primary care demand, and although it is “likely that NPs and PAs will continue to serve an important role in the provision of care, their numbers will not be sufficient to eliminate the emerging physician shortage.”
So rest assured generalist doctors, mid-levels will not take your jobs. Primary care remains a pillar of any health reform plan, as those calling the shots like Obama and Baucus even seem to realize. The only way to solve the problem will be to reform the physician payment system.
The politicians will come to realize that inevitable conclusion. Eventually.
topics: mid-levels, primary care
Related posts:
- Why nurse practitioners and physician assistants will not solve the primary care shortage
- Colonoscopy by primary care doctors, is it time to start joining the proceduralists?
- Medical students want to become primary care doctors, until reality hits
- Should specialists be re-trained as primary care physicians?
- Mid-levels for primary care, but not for surgery?
- Do mid-levels want to take over primary care?
- Foreign medical graduates and mid-levels will provide the majority of tomorrow’s primary care
{ 6 comments }
NEJM article on Innovation In Primary Care actually shows that PA’s and NP’s will take over much of primary care and move FP and Internists up stream (to higher paying jobs). http://content.nejm.org/cgi/content/full/359/22/2305
Kaiser Permanente Colorado employs approximately 300 primary care physicians, 77% of whom see patients less than full-time. Despite extensive support, the workload and stress of primary care have rendered it “not sustainable full-time” for many physicians, said Smith, the associate director for primary care and service. Turnover among Kaiser Permanente’s primary care doctors is much higher than among specialists, and Smith struggles to recruit enough primary care internists to replace those who retire or leave the area, much less add physicians to keep up with demand. “We’re unable to fill our positions as quickly as we need to,” he said. Doctors’ “panels have grown, and we’ve been working really hard to get them back down.” It takes 10 months to fill a vacancy for a general internist, as compared with 2 months to hire a physician assistant, so in the past 6 months, the organization converted six physician positions into slots for nine physician assistants or nurse practitioners.
“Luddite” Doctors who are afraid that more cost effective care providers will drive down their salaries will quickly change their tune once they realize that you don’t need an MD to treat a cough, the flu or coach a patient on diet and that any cost savings in low end care could be used to compensate more complex coordination of care.
I actually point out how many of the “innovations” in that NEJM piece is only applicable to large practices like Kaiser and the Mayo. 90+ percent of doctors in the country are solo or in small groups, making these ideas difficult to implement:
http://bit.ly/G5M3
Kevin
I do wonder what percentage of specialist NPs and PAs are essentially acting as primary care providers in OB/GYN offices. Most women seem to see an NP for their yearly Pap and breast exam these days.
Maybe mid-levels following algorithms and guidelines handed down from non-practicing academics is the solution.
These providers would be obligated to adhere to guidelines and – this part is key – would be immune from punishment if patient outcomes are less than perfect.
Diagnosis and management would be adequate at least half of the time, and that’s pretty good.
Australia has a much better health care system. Everyone who cant afford insurance is covered. And those who work and can afford insurance but refuse to buy it are taxed the same amt if they had just gotten insurance.
Australian GPs (IMs or FPs) are reimbursed by the govt at the end of each day. No questions asked. No wrangling. No fighting with insurance companies or bureaucratic redtape.
I recall many years ago when I entered practice being confused at the apparent youth of my East Asian colleagues. It was only then that one Dr. Veluswamy told me that in India, medical school begins immediately after high school. Hence their young age upon entry into practice. What is the blogosphere opinion?
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