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Dear Mr. MacStravic,

I’m not sure what the correct terminology is, but what about the issue of insurance continuity problem that an individual faces in this country. There is a significant disincentive for insurance companies to spend resources on a physician (and to a lesser degree nurses et al) doing ‘health management’ when they have no idea if they will see a benefit from that long term investment. Case in point is a child with diabetes; if a company spends resources on that child right now, they will almost certainly not be rewarded for pro-active long-term care as that child will change insurance companies many times as they go through high-school/college and into the work place.

I know there are *many* facets to this conversation, but until their is a market incentive and financial support for “proactive health management” (nice term), a shortage will continue.

Regards,
Adam

Scott you bring up some great points. In my two decade healthcare career I have seen countless turf struggles between physician providers and other mid-level providers (Physician Assistants and Advanced Practice Nurses) in several different clinical settings. I truly do not know whether this jurisdiction struggle as you put it is ego based or a fear of eventual replacement. I suspect it is a little of both. In any event the issue of sharing care responsibilities between MDs and mid-level providers generates some intense polarization within the healthcare arena.

The rising cost of care and difficulties with insurability have reached pandemic proportions. If traditional medicine is unable to respond to the growing healthcare needs of society – improved access, inexpensive care, higher quality care, and enhance patient safety, than it would make sense that the medical community adapt and utilize other resources such as mid-level providers to meet those needs.

Side lining willing and capable providers because of some obtuse jurisdictional domain smacks of pride and arrogance, and is not in the best interest of patients or the system as a whole. The physician portion of the medical community should be reaching out to mid-level providers and supporting their efforts. The entire community should come together as group and find ways of mitigating the significant issues that affect our healthcare system. I would like to say that there are many other MD providers that do support mid-levels, and their contributions are not taken for granted. We as a medical community need more of their voices to be heard.

What a great post. I especially liked your last paragraph. I think as we move to a different delivery model of healthcare all practitioners (both Physician and Non) need to leverage their expertise in new ways. A physician driven system may not be the best way, but physicans do have expertise. How will they use it to create better care paradigms? How can collaboration with pharm, nurses, allied health, and others focus more on patient outcomes rather then grasping on to tradition.

In a Banner owned hospital in Arizona Respiratory Therapists ahve been trained to insert central lines. They have 0 infection, 0 complications, and it frees up the docs for other things. Its these types of care shifts that need to occur if we are ever going to raise our level of care!

Thanks for the insight!!!
dan

[…] World Health Care Blog has a related post.  This excerpt highlights the challenge of moving away from the primary care physician to the more […]

[…] on April 15, 2008. WorldHealthCareBlog.org » Solving the Physician Shortage, or Protecting Their Market? : a hosted di… “… the vast majority of proposed solutions to the impending if not already arrived […]

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