Monday, February 4, 2013

Why More Non-MDs Will Be Treating Patients

The 2/3/2013 Wall Street Journal describes how, "Battles Erupt Over Filling Doctors' Shoes".

The problem of physician shortages has loomed for a while, but will get worse as more doctors retire (or cut back) and as new patients enter the system.  The problems did not originate with ObamaCare, but ObamaCare will make things worse.

This means many patients will have to wait longer for care or will be seen by various non-MD "midlevel providers" such as Physician Assistants (PAs) and/or Nurse Practitioners (NPs). 

From the WSJ article:
Many health-care experts say PAs will be in even greater demand when the Affordable Care Act expands insurance to 30 million more Americans next year. The Association of American Medical Colleges has warned that the supply of new doctors can't keep pace, due to limits on federal funding for medical residency programs, and estimates that the U.S. will face a shortage of more than 90,000 physicians by 2020, particularly in primary care and in rural areas.

The number of licensed PAs, meanwhile, has doubled in the past decade, to 86,500, and is likely to grow another 30% by 2020, according to the American Academy of Physician Assistants.

The AMA says it supports using PAs, nurse practitioners and other midlevel professionals in health-care teams as long as they are led by physicians and don't exceed their training. It says physicians must be available to consult with PAs at all times -- though not necessarily in person.
Many PAs and NPs are very good at what they do and can handle routine health issues.

As an advocate of free market reforms, I support allowing widened scope of practice for such providers, as long as it Is with the patient's knowledge and consent and as long as those providers recognize what they can handle and what needs to be "kicked upstairs" for more direct care by the MD physicians.

However, I think many patients will find that they will have to see the PA or NP out of necessity, simply because they will have no other alternative.

Given the worsening physician shortages, patients who wish to have continued access to an MD may wish to establish a firm relationship with a good primary care MD now.  And some of the new "concierge medicine" services (or the surprisingly affordable "hybrid concierge" services) may be worth investigating as well.  But the numbers of available openings will necessarily be limited.

If you wait too long, you might find that others will have beaten you in this game of medical musical chairs and your options may be more limited than you wish.  Prudent patients will wish to plan ahead sooner rather than later.