Who’s Your Doctor?

Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.

Comments (14)

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  1. John Fembup says:

    “the Affordable Care Act is boosting demand for primary care providers”

    This rings true. Yet I think there has been a recognized shortage of primary care physicians for at least 10 years maybe 20. ACA intensified this, but IMO did not cause it.

  2. Bubba says:

    I think it’s a good idea to open up primary care to more competition. Of course, doctors argue there is a difference — which there is. However, I also know that physicians have largely abandoned primary care for specialties. I don’t blame them. Once they have reached a level of achievement, it makes sense to specialize due to both interest and due to money.

  3. SPM says:

    A recent development is the decreased number of medical school application since Obamacare’s passage. This system is discouraging would-be doctors from entering the field, not encouraging it. It has been well documented that reimbursements to doctors for their services are falling, and so is their red tape. Medical liability insurance is also a huge problem.

    Obviously, Obamacare does nothing about this problem, except make it worse.

  4. Devon Herrick says:

    Over the past several years I’ve noticed how acceptance of nurse practitioners, physicians’ assistants and retail clinics has grown. I believe much of this change was due to the shortage of doctors who want to practice in a primary care setting.

    • Phill S says:

      Yes, I agree. It requires less schooling to enter into one of those professions, and they don’t have nearly the same headaches as doctors do. Although, we do have to be aware that the AMA will probably try to protect their own by trying to prohibit these other professionals from taking on greater responsibilities in the future.

      • James M. says:

        At this point, we need these medical professionals as a first line for medical care.

    • Thomas says:

      Perhaps also for those who want to work in the primary care setting, but have more sense than to go to medical school.

  5. Jimbino says:

    It’s getting ever more clear that your best bet for finding primary car is to fly, drive or take a bus to Mexico! Or Costa Rica, Brazil, Argentina, Czech Republic, Hungary, Thailand or India if you can afford it.

    • Devon Herrick says:

      You don’t need to board a plane to get primary care. The cost of an airline ticket and hotel for the night in San Jose’ Costa Rica would probably buy all the domestic primary care physician visits the average American uses in a year.

      Primary care is plentiful if you are willing to pay cash (or have comprehensive insurance). It’s only when your health plan (including Medicare and Medicaid) reimburses primary care at a low rate does it become hard to schedule an appointment.

      • John R. Graham says:

        I’m not sure I’d fly to India for primary care. Actually, I am sure I would not. For an operation? That is very possible.

  6. Matthew says:

    “As we’ve said before, Obamacare does nothing to boost physician supply.”

    If anything, the new regulations may hinder future supply as working in their practice becomes much more demanding. Who would take the chances of becoming a doctor in a post-ACA world?

  7. Dr. Mike says:

    When you don’t know what you don’t know, you’re in trouble…
    Did you know that the first nurse practitioners were nurses with years of experience?
    Did you know that now it’s possible to become a nurse practitioner with zero experience outside of nursing school?
    Did you know that the average family physician completes his residency with 18,000 hours of clinical training?
    Did you know that the average NP completes their degree with less than 3000 hours of clinical training?
    Did you know that it is possible to get your NP degree online?
    Did you know that regulation of physicians in each state is controlled by the medical board whereas NPs are regulated by the nursing board, and that each board has different standards?
    Did you know that in my training I was able to see each of the common medical conditions across the full spectrum of severity? Take pneumonia for example – I saw it in the clinic, at urgent care, in the ER, on the medical floor, in the ICU, on a vent and during the code – very few NPs can say the same. Are you sure that cough isn’t pneumonia? You do realize the x-ray results are usually negative early on in the illness, right?
    Do the above FACTS mean that I am anti-NP? Absolutely not. I love having them as part of my healthcare team. But can they replace me? Are they equivalent to me? lol.

    • Devon Herrick says:

      Various studies have found a high degree of satisfaction among patients who see NPs/PAs. Studies have also failed to uncover evidence of harm. That said, nobody is suggesting NPs and PAs can replace physicians; or that they are equivalent in training.

      The fact remains, many physicians do not want to work in primary care. Physicians have told me that the pressure to specialize starts early in medical school. Maybe physicians don’t believe primary care is challenging; or perhaps that the pay is too low for the hours spent.

      I know people who would never see anything but a physician. I also know people who will opt for a PA or NP if the wait is shorter. Indeed, some people see a NP/PA because they feel they have a better rapport with them. I believe this should be a choice left up to consumers to make.

      • John R. Graham says:

        I concur. I am not a physician, so I temper my remarks. We do not assert the equivalence of NP with MD, but neither do NPs! I have been told by NPs that part of their training is to be able to identify when they have hit their limit of expertise, and refer to an MD.

        What is the best way to organize a care team? I am sure there are good principles, like in any organization. However, local conditions will surely determine the best organizational form, and government should not weight too heavily on it.

        A few years ago, I reviewed the scope of practice regulations of NPs and other “allied health professionals” in the states. Alaska had the broadest scope of practice. I concluded that it was because it was very hard to get MDs to remote Alaskan communities, so the state had to have pretty liberal (if you’ll excuse the term) regulations.