With health reform possibly passing within the next few months, attention now turns to the primary care doctor shortage.
Regular readers of this blog know that there are not enough primary care doctors currently; it’s frightening to think what would happen if an additional 40+ million newly insured patients start looking for care.
A recent piece from Newsweek nicely encapsulates the problem. It’s a good piece, elucidating the myriad of reasons why new medical students shy away from the field:
The close relationships that general practitioners once had with patients drew many idealistic students into the field. Now recruiters face an extra-tough sell: they have to convince bright young would-be docs to pursue a career that won’t pay very well and won’t be as emotionally fulfilling as it once was.
There are some who believe that primary care offices don’t necessarily need to be staffed by physicians; nurse practitioners and physician assistants can help reduce the shortages. And by the way, replacing doctors would be a great way to cut costs.
The problem is both nurse practitioners and physician assistants aren’t immune to the financial incentives swaying doctors away from primary care:
The problem with taking this approach nationwide is that nurses and PAs are subject to the same economic forces that drive medical students. Almost half of current nurse practitioners and physician assistants work in specialty practices, where the money is. Then there’s the fact that the country already has a nursing shortage. How are nurses going to replace doctors if there aren’t enough nurses to begin with?
Spending more money on primary care — and according to the American Academy of Family Physicians, we’re talking at least 25% more — is the best way to get the attention of not only medical students, but also aspiring primary care nurse practitioners and physician assistants.
Similar Posts:
- Some doctors may resist the primary care team approach
- Primary care and the three year medical student
- Primary care doctors at a competitive disadvantage to midlevels
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$ make “sense”
Sorry I forgot to do a basic budget breakdown that illustrates my focus on incorporating good team science in primary care.
Say we have a team of :
MD, APN, RN & (licensed)
CMA/Certified health worker (unlicensed but certified)
APN salary ave $45/hr
RN salary ave $ 27/hr
(10 yrs plus but likes ambulatory care &
we have data that is often the case since hosp
care is challenging/high burn out area)
CMA/ CHW salary ave $14/hr
So essentially as MDs need to monitor team efficiencies you need to determine what staffing level meets:
Patient satisfaction
Non pharm & Pharm guidance.
Nonpharm can come from all personnel
Pharm guidance from RNs with protocols
(ie. Certified Db educators/ Certified Asthma managers)
APNs/ PAs can see & prescribe but who are you comfortable with them seeing & when. In other words should late evening visits by APNs/ PAs be only semiurgent but less chronically ill. That is until the MDs train the staff
1/3 of offices utilize these personnel. Perhaps we need a meta analysis of the best training practices.
Clinical utility & Patient satisfaction may be enhanced with good capital management. That includes intellectual capital.
If CHWs can do nonpharm at 1/3 the price of APNs, why not give them the lifestyle classes. (Which we know have challenging adherence rates anyway).
A statistician & good HR consultant can stratify the costly end for your business. In addition, a good certified RN can see the emotional cases up front & reduce the MD conversation time. (This is no different than an executive VP delegating to account reps). It is a better attempt at maintaining clinical utility.
Perhaps we need to expand the space to allow patients to vent longer with less expensive personnel. Adding space is usually cheaper than adding personnel.
In addition, cross training personnel is usually cheaper as well. (RNs with phlebotomy or with case management certs are one example. PAs/ NPs with suturing or stress test experience are another).
Retraining is also cheaper than firing. Some examples of groups that will train NPs/ PAs further include:
Fitzgerald Health Education Association
Practicing Clinicians Exchange.
Please understand that this message does not mean that your current practice is following good management guidelines. In fact, I also want to express best wishes for all that you already do. It is just that HC is so expensive now, every dollar counts. The most prudent managers make the most of the team.
Kit.
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