Mid-levels for primary care, but not for surgery?

Do most surgeons think mid-level providers can replace primary care physicians?

That much was implied during recent testimony by the American College of Surgeons’ John Preskitt, who said, “With trauma care and surgical emergencies, there are no good substitutes or physician extenders for a well-trained general surgeon or surgical specialist.”

The ACP’s Bob Doherty took that to mean that there were good substitutes for primary care doctors.

That may, or may not, be true, and it’s obvious we are seeing the seeds planted for a vicious turf war that will inevitably erupt as we move forward in health reform.

There is a school of thought that mid-level providers, like physician assistants and nurse practitioners, can be trained to do minor surgical operations and procedures. In fact, some think that may be a more appropriate venue for them, rather than managing a complex patient with multiple chronic issues.

In any case, the incentives that sway physicians towards procedure-based specialties affect mid-levels as well, and I would not be surprised to see them start training to do procedures like colonoscopies and minor operations soon.

So, if I was a subspecialist or general surgeon, I wouldn’t get too comfortable thinking that only primary care doctors could be so easily replaced.

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