Oct 10, 2019
What's the deal with nurse practitioners (NPs)? Why is there
so much anger from physicians and NPs when it comes to how patients
are treated? Every day on my twitter feed I hear about how nurse
practitioners and physician assistants and others are "acting like
doctors without the necessary training" and are "dangerous because
they know nothing." Meanwhile my friends who are NPs and PAs cite
studies that claim they provide just as good if not better care
than physicians because they are more compassionate and willing to
listen, etc. Both camps are hogwash.
In reality, this is an argument that is about scope of
practice and not about what we should really be discussing - which
is patient autonomy and freedom to see whom they want. Physicians
and other physician extenders/midlevels battle it out every year
spending millions of dollars lobbying in state legislatures and in
DC to restrict and expand what non-physicians can do under their
occupational license. We wrap these arguments under the guise of it
being about patient safety or saving the health system money or
giving patients choice when it isn't really any of those
As professionals in health care we have been bamboozled into
believing that the only way to run our businesses and health care
is by restricting choice and allowing insurers (government and
commercial) to dictate to us how much they pay. Because we aren't
allowed to set prices based on what we believe our value is in the
marketplace we end up with massive regulatory and legislative
battles that don't help patients at all.
President Trump, who has issued a number of very helpful
executive orders to allow some freedom of choice in the health
market, just issued an executive order that calls on the federal
government to pay the same for every visit. This means that no
matter who performs the visit it will be paid the same regardless
of the level of training and experience of the professional seeing
the patient. This will undeniably lead to an increased use of NPs
and PAs instead of physicians since their pay is less and their
revenue will be the same. Ultimately, this is because patients
aren't allowed to pay a premium or receive a discount in the
marketplace based on their personal choice.
We continue to allow the empire to
decide how we will be paid, who will be paid, and in what way. As
long as we allow this we will get the kind of health care we
deserve - expensive, lousy, and no patient freedom.
Non-Profit Hospitals are Making a Killing: President Trump's
Executive Order that will lead to 100% reimbursement amounts for
any level of health care provider which will inevitably increase
the amount of non-physicians taking care of patients. Section 5c is
the relevant one to review.
Episode 022: Recent
discussion with Dr. Bernard highlighting the failure of government
run entities who mandate the use of NPs is not best for
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