Out-of-context quote of the day: “We have no malls and no Walmart. Recruitment is nearly impossible.”
These astonishing statements were made by Elizabeth Nelson, a nurse practitioner in Nebraska. She was not talking about teenage summer jobs. She was not talking about professional Walmart greeters, addicts of cheap stuff made in China who want an employee discount, or people who really like Cinnabon. She was talking about doctors.
The funny (or sad) part is the thought that anyone would consider the presence of a Walmart to be the defining element of a great zip code. I don’t think Ms. Nelson really meant this. I think she was pointing out that there’s not a whole lot of, well, anything, in Nebraska. Nebraskans presumably like it that way.
Here’s the irritating part. The rest of the paragraph: “The doctor shortage remains. The hospital, Brown County Hospital in Ainsworth, Neb., has been searching for a doctor since the spring of 2012.”
Brown County Hospital has no doctor. None. Someone from South Dakota comes once a month to do paperwork and see patients. So, Ms. Nelson has been providing the care in the emergency room at Brown County Hospital. If she gets in real trouble, she goes online and speaks to the doctor in South Dakota.
Seeing this problem, Nebraska passed a law in March that said that nurse practitioners no longer need physician oversight to practice independently. They’re doing it out of necessity. The Nebraska Medical Society and the AMA predictably opposed this legislation, as they have in a half-a-dozen other largely rural states that have passed similar laws.
According to the New York Times, Dr. Robert Wah, the president of the AMA, said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”
OK, fine, Dr. Wah. If you believe that, then why don’t you help send doctors out there? If the AMA wants so badly to prevent NPs from practicing independently, and believe me it does, mostly for turf reasons, where is the political advocacy for a reasonable cost of medical school, better tuition repayment, and increased Medicaid reimbursements? Is Dr. Wah willing to go be the head of the physician team at Brown County Hospital? No. Neither he nor any other doctor is.
Instead of funding another study to “prove” that NPs cannot practice primary care as well as physicians, fund a primary care physician. In Nebraska. Preferably one that doesn’t like Walmart.
Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.
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