Am I famous yet?
Wow. A lot of push-back from readers on my recent post about Nurse Practitioners, which was guest-posted on KevinMD. I am very pleased to spark such great discussion. Here are some of the points brought up:
1. “I’m an anesthesiologist. Why am I harshing on primary care doctors?” I’m very sorry if it appeared that I was. I believe physician extenders can be useful in all medical fields. Certified nurse anesthetists are wonderful. They can do everything I can do managing routine cases, and most of anesthesia is routine cases.
2. “You think physician extenders should be allowed to practice independently.” I never said this. If there’s a shortage of primary care doctors, let PA’s and NP’s handle all the routine stuff. Have the doctor oversee, consult, and spend his/her time talking to and listening to and examining patients who need a person with more training. If there were a shortage of anesthesiologists I would say let the CRNAs handle all the routine stuff and have the doctors handle the complicated stuff.
3. “So what DO you need an MD for?” The hard stuff. The unusual stuff. The stuff that requires the doctor to use all that education he has.
4. “I don’ see you advocating for your own physician extenders, CRNAs.” Wow. Sorry about that. I advocate for them every day, it just wasn’t made clear in my article.
5. “What about billing?” This is not about money, at least in my case. The department chairs and lobbyists will push for anesthesia turf. I have no interest in that game. Health care is expensive and costs WILL be cut, in ways doctors don’t like, unless we step up and accept ways to cut our own costs that work for us.
Look at it this way: Say you go to the dentist. Who do you spend most of your time with? The hygenist. Why? Because there is no reason for the dentist to do what a less-trained person can do just fine. The dentist comes in to chat and deal with any problems that arise from the examination of the hygenist. The dentist does the hard stuff, the stuff that requires all his education. Medicine can be the same way. All doctors complain about paperwork and other distractions from the care of patients. Primary care doctors especially feel this way because they get an unfair percentage of this burden. So make primary care an awesome place to be by taking away all that stuff. Let the people with less training go in and do the cleaning and the paperwork. Let the doctor do the hard stuff. Everyone would want to be a primary care doctor because it would be so nice to be freed of all the extraneous bulls—.
Let’s get doctors back to doctoring. Let everyone else do the rest. That’s all I’m saying.