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If only they had a Walmart!

May 26, 2015

Funny/sad/irritating/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 really like Cinnabon.   She was talking about doctors.

The funny/sad part is the thought that anyone, doctor, plumber, SAHM or astronaut, 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. http://nyti.ms/1HFm62F

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.

So, 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 anyway, 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 A.M.A., 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.

 

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5 Comments
  1. Is it time to consider allowing properly qualified Naturopath Doctors (who have at least 4 years of medical education) fill these vacant roles, in collaboration with nurses, until primary care physicians are finally available? just curious….

    • Jen permalink

      I am taking some liberties here and playing the devils advocate…Out of curiosity do you mean a Naturopath who has completed a PhD (aka Doctor..). Or is this a person who has completed a medical degree and then further studies into ‘natural’ therapies e.g. nutritional medicine or Traditional Chinese Medicine so they may also offer ‘Eastern Medicine’ options to their patients. And what is ‘properly qualified’; is it practicing under acts of parliament (e.g. poisons act, mental healthcare act etc..), is it healthcare practice that is grounded in robust scientific findings (as much as possible) that is very often not static, also being professionally traceable and accountable before your board, required to meet ongoing professional body credentialing status (and pay for the privilege every year)? I have a deeper respect for the physical assessment, diagnostic and pharmacotherapy skills that doctors are required to obtain in order to practice, all since I began my masters degree to become a nurse practitioner (that year of pharmacology studies was tough!). I don’t see myself taking the place of a primary care physician, even though I work in an area of GP shortage. I do however look forward to a collaborative working relationship to provide healthcare in an area of high need with much chronic disease, particularly diabetes (my area of nursing expertise). I disagree with any notion of ‘back-filling’ until primary care physicians are available. Is that not just a short term seemingly ‘second best’ (and far cheaper) solution, taking the place of long term planning and commitment to provide equitable healthcare regardless of your geographical location. This is a commitment needed by politicians and policy makers. I know there is a turf war and at times a greying of professional boundaries and no simple solution to mediation that I can see. However I do also see some great collaboration within certain well defined specialties with working relationships where the patient is set to win all round. Lets face it, there is plenty of work for all manner of healthcare providers if you can sell yourself and your service. But that’s not the issue; if my child was sick, I know who I would want to take them to and I will never compromise on that!

      • hi, no, i am not referring to a PHD person. Having said that, this discussion is open for others to contribute to, who have a stronger background in this topic than I do. i merely commented because a vacancy and dearth of doctors in certain geographic locations seems to be an issue in itself. so what is the solution? i dont know. but the status quo does not seem ideal either….sabina

    • Lala permalink

      Naturopaths aren’t doctors. They prescribe herbs and homeopathic remedies. In some places they’ve been allowed to prescribe a few medications like antibiotics, but in no way, shape or form are they “doctors.”

      In the same manner that some state legislatures allow the teaching of creationism as a false alternative to evolution, some legislatures allow the practice of naturopathic medicine as an alternative to allopathic or osteopathic (mainstream) medicine.

      Ever try curing cancer with hopes, wishes and prayers? How about coffee enemas and vitamins?

      Naturopaths are *not* doctors.

      https://www.sciencebasedmedicine.org/legislative-alchemy-naturopathy-2013/
      http://scienceblogs.com/insolence/2011/02/28/naturopathy-versus-science/

      Their “4 years of medical education” isn’t nearly as comprehensive as what is studied at traditional medical schools–if it was naturopaths would have MD or DO degrees, not NDs. They study ayurvedic medicine, traditional Chinese medicine, acupuncture, homeopathy, massage therapy, “energy flow,” and other similarly non-medical topics. Sure, they have some similar classes, like basic anatomy & physiology, and intro pharmacology–but at no point are these classes as rigorous as those taught to medical students.

      What I find funny are the google results for ‘ND vs. MD.’ It would seem that every naturopathic school and doctor in the country has their own webpage all about how similar the ND curriculum is similar to an MD curriculum. And then massages the data to make it seem as if ND students not only spend more time on classwork, but also more time on clinical projects, lol. And then fully leaving out the 3-7 years that MDs and DOs spend in residency before they’re allowed to practice 100% independently. Do NDs do the same type of residencies? Nope.

      Once again, naturopaths are *not* doctors.

  2. I agree that a ND is not the same as a MD. I was merely agreeing that there is an issue if there are insufficient numbers of MD’s that are willing to live in certain towns. How can this issue be resolved? That is my real question, just as it is Sherie’s question too. How do you help service the medical needs of towns where MD’s do not want to move to? What are some realistic options? (with due respect to MD’s who do not want to live in such towns)? sabina

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