The debate over whether there really is a physician shortage is starting to heat up.
A commentary in CNN
makes the argument that we don't need more doctors, instead primary care should be shifted more to nurse practitioners:
However, we submit that these actions lead us in the wrong direction, and there is, in fact, no doctor shortage -- as long as we accept the fact that health care can work differently, and better than, the current system.
What's your take on this issue?
The people that wrote that book discussed in the CNN article are at worst merely incorrect and at worst absolutely misleading. I'll bring up a few points.
If job satisfaction were really the issue, we'd see people avoiding orthopedic surgery, OB/GYN, ophtho, hospital internal medicine, and ENT.
All of those except for hospitalist are some of the specialties students seem to love to go into (especially ortho and ENT) and none are primary care. The happiest physicians were in pediatrics, geriatrics, neonatology, and derm. Pediatrics and geriatrics are the biggest components of primary care. So, it obviously isn't job dissatisfaction causing people to not go into primary care. Everything I've seen points to lower pay and lower prestige being the pain factors.
The article says that algorithms and EMRs can basically replace clinical knowledge and experience and allow people with less training to do more specialized work. Anybody who's actually been in a clinical setting for very long will tell you that doesn't usually work very well. Sure, it would work reasonably well with patients who are textbook cases. But generally the only time you see those is when somebody screwed up and let a nonspecific early presentation of a disease go untreated (or improperly treated them) and it progressed into a fulminant textbook case and the patient is in far worse shape. For example, necrotizing fasciitis is easy to diagnose when the patient has large areas of skin sloughing off them. However, they stand a much better chance of living when an experienced physician sees a patient who has a little too much pain for the relatively mild swelling/redness, suspects necrotizing fasciitis, and starts them on antibiotics STAT. Even with all of the technology we have now, medicine still has a lot of "art" of being able to recognize situations and think of things outside of the algorithm box.
The article does not address the reason why seeing an NP for certain conditions is less expensive than seeing an MD. Seeing NPs instead of MDs is basically an arbitrage against laws mandating licensing requirements, education requirements, and legal liability. Anybody who has taken Econ 101 (and I would assume somebody with an MBA worth the paper it's printed on would have taken it) knows that arbitrage is a temporary
condition that the market will
correct. People will expect NPs to do more things than they currently do, which will mandate more training. NPs are human like anybody else and with greater autonomy, their mistakes will be increasingly seen as their own (instead of being the responsibility of the supervising MD), and they will have greater liability exposure. So after a period of time, you will have turned NPs into what primary care MDs were, complete with the same expenses- and you'll pay the same to see them because of this.
My real $0.02 about the issue is that we need to tackle the reasons why it is so expensive to see a primary care MD and attack those instead of trying to temporarily skirt the problem. However, those problems are far more difficult to address and will step on toes of people with far more political clout than doctors have, so few want to tackle them. Case in point: notice how tort reform is not mentioned anywhere in the healthcare reform bill? That wasn't accidental.