More on the End of Primary Care
Salon.com has a piece today on the shortage of primary care physicians. It's a pretty good summary of a
bleak situation.
Just as the U.S. financial gurus failed to acknowledge the seriousness of our present credit crisis, today's politicians are avoiding what promises to be a similar catastrophe in healthcare -- the availability of primary care physicians.
The current healthcare debate about accessibility and affordability reminds me of a committee of well-intended E.R. doctors furiously debating the optimal cost, shape and efficiency of various tourniquets, while a casualty victim slowly bleeds to death. Better and more widespread and affordable health insurance won't be of value if you can't find a primary care provider willing and happy to treat you.
Make no mistake: Primary care is the backbone of a good medical system.
Link
It would be interesting to see a response piece by a PA, arguing that PAs are a potential solution to the shortage of primary care physicians. That is, could be a solution if PAs weren't actively avoiding primary care, as well.
The only mention of PAs is in this paragraph:
To begin with, the reality is that much of office medicine is an art, not a science. The majority of our doctor visits aren't for life-threatening illnesses for which statistical outcomes can be determined. Common problems such as uncomplicated low back pain or a chest cold will resolve irrespective of treatment, or could be dispensed by a nurse practitioner or physician's assistant at a reduced cost. The expense of medical training can never be cost-effective if most medical problems don't require such expertise and can be handled at a fraction of the cost by lesser-trained personnel.
Yet it is this hard-earned expertise that is necessary to ferret out the minor from the serious.
This thinking has become conventional wisdom. That while PAs and NPs can do almost everything that a primary care physician can do, extensive physician training allows them to spot life-threatening zebras that PAs and NPs would miss.
I find this to be baloney.
I don't think there's much difference at all between a relatively experienced family practice physician and a relatively experienced family practice PA or NP. I'll take a good PA or NP over an average family practice physician any day.
Physicians don't want primary care. They are abandoning primary care—and abandoning patients in the process. It's time for them to step back and formally cede family medicine to PAs and NPs. Or NPs alone if PAs don't want it.