Solving the Physician Shortage, or Protecting Their Market?
by Scott MacStravic
The impending shortage of physicians, particularly primary care specialists such as family practitioners, internists, pediatricians and geriatricians, has been shouted about by medical professionals as well as health care gurus of many stripes. It has been used as a reason to criticize concierge practices, despite their affecting only about 1/1000th of all physicians so far. It has also been used as an argument for rescinding Medicare cuts to primary physician payment schedules, and for adding new payments for their “medical home” and “proactive health management” services.
More recently, the medical profession has taken on developments such as retail clinics which use nurses or physicians’ assistants, rather than physicians, on grounds of quality concerns. The fact that these clinic offer more convenient care at lower prices, hence take away lucrative patients and visits from physicians is by no means ignored, though never mentioned by physicians, themselves, as a reason for their objections.
Meanwhile, the vast majority of proposed solutions to the impending if not already arrived “health care cost crisis” and even the promotion of health insurance for all, depend to a great extent on the mis-labeled health care system actually moving more to health vs. sickness care. This would normally be the logical jurisdiction of primary physicians, except that there are nowhere near enough of them, and they are not particularly adept at it, plus being the most expensive source of health management care available. Though some have proven their abilities in disease management, only those functioning in concierge practices, which many physicians also object to, seem to be making a go of health management.
While they may argue as much as they wish about nurses and other non-physicians being involved in sickness care, there are few and far weaker grounds for objecting to nurses, physicians’ assistants, pharmacists, etc. from being primary sources of health management services. Nurse coaches already function as the main sources of coaching for people participating in health risk and chronic disease management programs offered by insurers, specialized suppliers, and healthcare organizations who provide such services.
Pharmacists have been demonstrating for years their high level of cost-effectiveness in managing the conditions of chronic disease patients, such as diabetics, whose care is largely dependent on medications and adherence to their prescribed use. The Asheville, NC example of diabetes management using pharmacists has been delivering amazing results for a decade. The Diabetes Ten City Challenge combines pharmacist diabetes management with value-based insurance operates in ten cities for 29 self-funded employers. [L. Masterson “A Prescription for What Ails Us?” HealthLeadersMedia News: Health Plans, Apr 2, 2008 (healthplans.hcpro.com)]
The use of non-physician health professionals to deliver the vast majority of the kinds of services that will be needed to achieve the kind of reduced incidence of disease and injury on which the survival of our health care system depends is not merely a desirable, but an essential reality. Perhaps it is time for physicians to work on how to engage and coordinate their special expertise with the rest of the wide range of health professionals out there, rather than devote so much energy to protecting their own jurisdictions.
