August 16 2013
Patrice J. Lee
A David-Goliath battle is brewing in California that pits nurses and health practitioners against doctors for our bodies. The stakes are high as California will have to deal with offering medical care for potentially millions of new patients once Obamacare kicks in this fall. And there are national implications; eyes are trained on what happens here as other states may follow.
Legislation is making its way through the California legislature that would allow nurse practitioners to take care of patients without a doctor’s supervision. Another (less contentious) bill would allow pharmacists to independently provide vaccines, hormonal contraceptives and some nicotine replacement drugs.
This is a critical case for many reasons. One of the biggest is that as the mandated health coverage under ObamaCare takes effect, there will be a swelling of new patients at hospitals and doctors’ offices looking for care. And –if you haven’t heard—there’s currently a doctor shortage across the nation. Imagine how overwhelmed doctors will be once their waiting rooms fill up with new patients.
The national lobbying association that represents doctors is throwing its weight behind fighting –what I’m calling– the nurse’s freedom act, supposedly because they fear for the safety of patients:
“If SB 491 becomes law, nurse practitioners will be allowed to practice without any supervision by a physician, despite the enormous differences in education and training between the two.
SB 491 allows nurse practitioners to diagnose and treat patients beyond their capabilities and without any additional training, jeopardizing patient safety."
Do you buy this claim? I don’t. I think they are fearful of the competition.
I agree with supporters of the bill, including the legislator who drafted the bill Ed Hernandez, that this is an important measure to expand access to quality healthcare. According to Hernandez, nurse practitioners, pharmacists and other medical providers can help provide access in places where there are not enough doctors to meet patients' demand. "If we are going to be mandating that every single person buy health insurance, then we better make sure that there’s enough people to see these people safely."
So is the quality of care these non-MDs provide worse than doctors as the doctor cartel would have us to believe? Nope. Here’s what a recent study finds:
Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar. For example, a systematic review of 26 studies published since 2000 found that health status, treatment practices, and prescribing behavior were consistent between nurse practitioners and physicians.
What's more, patients seeing nurse practitioners were also found to have higher levels of satisfaction with their care. Studies found that nurse practitioners do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services. The patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care.
No wonder the MDs have their stethoscopes all in a twist! But they should see this as a great financial opportunity. Doctors specializing in specific fields far outweigh general practice doctors. Why not just allow the market to dictate the future of general practice doctors? If nurse practitioners are able to provide much of the general practice care that patients look for such as the annual check-up and screenings for diseases, the market may shift all doctors to specializing which will drive up their (monetary) value to society. Sounds like a win-win for everyone.
Matthew Yglesias highlights in Slate that there’s another huge upside to a measure like this bill: it creates jobs. Not just low-skills or high-skills jobs, but mid-skills jobs that middle class Americans can secure with moderate training. That’s something everyone can get behind since it doesn’t require changes to immigration policy, lowers unemployment and boosts economic activity.
Given the tsunami of an aging baby boomer population and implementation of mandated healthcare, our health care system will need as many more new health service providers as possible.