Expanding Primary Care Availability With Nurse Practitioners
Expanding Primary Care Availability With Nurse Practitioners
In the "The Coming Shortage of Doctors," a 2009 Wall Street Journal op-ed, Dr. Herbert Pardes, CEO of New York Presbyterian Healthcare System wrote: "None of the health-care reform proposals advancing in Congress address a fundamental problem that will soon face this country: a critical shortage of doctors". Despite some attempts to relieve this shortage by legislation and federal policy the fundamental problem remains.
Americans in urban and rural settings have difficulty finding a physician when they need one, and it is rare for a patient to get an appointment with a physician without waiting at least a few days. People in need of easy, quick access to health care services frequently experience difficulty being rapidly seen for colds, sore throats, upset stomachs or a school team or employment physical. Walk-in clinics of various kinds are one growing response to these needs. Often, people cannot find a physician who will see them regularly and provide continuous care for chronic diseases and increasingly will be in need of easy access to comprehensive primary health care. This shortage of primary care physicians across the country compounds the difficulty patients have in seeking and obtaining care.
The journal Social Science and Medicine predicts that by 2025 "most primary care physicians will have disappeared from the medical care scene". Doctors are not choosing to go into the primary care specialties of family medicine and general internal medicine in sufficient numbers to meet the needs of the public. Frequently, physicians who functioned as general practitioners have left practice through death and retirement and have not been replaced by younger physicians. Medical practices that were once profitable and saleable are now being abandoned, Diminished access to care has been further exacerbated when urban and rural hospitals close and services previously available from emergency rooms and clinics have disappeared. The net result is that the public has lost significant access to medical services. Organizationally and financially, it has been difficult for institutional providers or insurers to step in and fill this gap.
The New York Times on April 26, 2009 identified a "Shortage of Doctors as an Obstacle to Obama Goals". An opinion piece written by a physician in The Wall Street Journal commented on the effects of President Obama's expanded health insurance plans: "The medical turnstiles will be the same as they are now, only they will be clogged with more and more patients. … The doctors that remain in this expanded system will be even more overwhelmed than we are now".
The reluctance of physicians to enter or continue in primary care has come to pass for many reasons. Primary care physicians have high practice expenses, often on top of enormous debt from undergraduate and medical tuition, yet they have lower incomes than specialists. They face tasks not many physicians find satisfying, professionally challenging or lucrative such as: time consuming paper work, phone negotiations with third party payers for payment approvals, restrictive clinical guidelines, and the shift to providing palliative care to the chronically ill. Now, there are the costs and complexities of practice attributable to the imminent advent of accountable care organizations and federal mandates requiring electronic health records and prescribing as a condition of being fully compensated. New responsibilities will be placed on office staffs to follow up on aberrations identified by computers in order to meet the standards of care demanded by the government, insurers, and accrediting and licensing agencies.
Federal legislation, regulations and payment arrangements that shape Medicare, and state administrations which control Medicaid, have determined much of the organizational response of health care providers to the provision of services. Restrictive legislation, implementation of bureaucratic regulatory policies and procedures, professional territorial imperatives and the political process have inhibited change and the development of new mechanisms to organize and provide care while, at the same time, allowing and advancing costly innovations in medical care. Recent federal legislation has introduced concepts which suggest how care might be organized in the future that will be more patient-centered and cost-effective. It is not currently known whether these legislative changes, which are ideological rather than market derived in origin, will succeed, but new organizations to provide primary care will have to be designed to accommodate and effectuate them.
The Shortage
In the "The Coming Shortage of Doctors," a 2009 Wall Street Journal op-ed, Dr. Herbert Pardes, CEO of New York Presbyterian Healthcare System wrote: "None of the health-care reform proposals advancing in Congress address a fundamental problem that will soon face this country: a critical shortage of doctors". Despite some attempts to relieve this shortage by legislation and federal policy the fundamental problem remains.
Americans in urban and rural settings have difficulty finding a physician when they need one, and it is rare for a patient to get an appointment with a physician without waiting at least a few days. People in need of easy, quick access to health care services frequently experience difficulty being rapidly seen for colds, sore throats, upset stomachs or a school team or employment physical. Walk-in clinics of various kinds are one growing response to these needs. Often, people cannot find a physician who will see them regularly and provide continuous care for chronic diseases and increasingly will be in need of easy access to comprehensive primary health care. This shortage of primary care physicians across the country compounds the difficulty patients have in seeking and obtaining care.
The journal Social Science and Medicine predicts that by 2025 "most primary care physicians will have disappeared from the medical care scene". Doctors are not choosing to go into the primary care specialties of family medicine and general internal medicine in sufficient numbers to meet the needs of the public. Frequently, physicians who functioned as general practitioners have left practice through death and retirement and have not been replaced by younger physicians. Medical practices that were once profitable and saleable are now being abandoned, Diminished access to care has been further exacerbated when urban and rural hospitals close and services previously available from emergency rooms and clinics have disappeared. The net result is that the public has lost significant access to medical services. Organizationally and financially, it has been difficult for institutional providers or insurers to step in and fill this gap.
The New York Times on April 26, 2009 identified a "Shortage of Doctors as an Obstacle to Obama Goals". An opinion piece written by a physician in The Wall Street Journal commented on the effects of President Obama's expanded health insurance plans: "The medical turnstiles will be the same as they are now, only they will be clogged with more and more patients. … The doctors that remain in this expanded system will be even more overwhelmed than we are now".
The reluctance of physicians to enter or continue in primary care has come to pass for many reasons. Primary care physicians have high practice expenses, often on top of enormous debt from undergraduate and medical tuition, yet they have lower incomes than specialists. They face tasks not many physicians find satisfying, professionally challenging or lucrative such as: time consuming paper work, phone negotiations with third party payers for payment approvals, restrictive clinical guidelines, and the shift to providing palliative care to the chronically ill. Now, there are the costs and complexities of practice attributable to the imminent advent of accountable care organizations and federal mandates requiring electronic health records and prescribing as a condition of being fully compensated. New responsibilities will be placed on office staffs to follow up on aberrations identified by computers in order to meet the standards of care demanded by the government, insurers, and accrediting and licensing agencies.
Federal legislation, regulations and payment arrangements that shape Medicare, and state administrations which control Medicaid, have determined much of the organizational response of health care providers to the provision of services. Restrictive legislation, implementation of bureaucratic regulatory policies and procedures, professional territorial imperatives and the political process have inhibited change and the development of new mechanisms to organize and provide care while, at the same time, allowing and advancing costly innovations in medical care. Recent federal legislation has introduced concepts which suggest how care might be organized in the future that will be more patient-centered and cost-effective. It is not currently known whether these legislative changes, which are ideological rather than market derived in origin, will succeed, but new organizations to provide primary care will have to be designed to accommodate and effectuate them.