Monday, February 11, 2013

Adalja On Non-MDs And Licensing

Dr. Amesh Adalja notes that "Sometimes The Best Medical Care Is Provided By Those Who Aren't M.D.s" (Forbes, 2/10/2013).

From his piece:
...[F]or many conditions the expertise of a physician is not strictly required and an individual may be ably served by a nurse practitioner or the like. Expanded scopes of practice, in which a non-physician renders care independent of a physician, not only expand access to health care and have the potential to decrease the cost of healthcare, but also reflect a respect for the free market system.
Like Dr. Adalja, I support the elimination of licensing laws the unfairly restrict the ability of health professionals and patients to voluntary contract to their mutual benefit.

In a free market, patients might choose rationally some forms of medical care from an MD (and pay a higher fee) and other forms of care from a non-MD "mid-level provider" for a lower fee.  Provided that there is no fraud or misrepresentation by the provider to the patient, this can be a win-win for both parties.

(See also my related piece: "How Medical Licensing Laws Harm Patients and Trap Doctors", PJ Media, 10/1/2012)

However, we may also see state governments loosening some scope-of-practice laws for other, less-benign reasons.  The Los Angeles Times recently reported, "State lacks doctors to meet demand of national healthcare law" (2/9/2013).

The LA Times article notes:
There aren't enough doctors to treat a crush of newly insured patients. Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.
In this case, the motivation of the state of California is different.  The proposed changes in the laws are not driven by a respect for individual freedoms, but because of the growing problems of the government health program.

Patients won't be choosing between MDs and non-MDs for medical care in a free market, but instead obliged to accept care from whichever providers still willing to practice under ever-growing state control.

Considered in isolation, the specific concrete legal changes in California might be similar to genuine free-market reforms, but the larger context is very different.