Here come the nurses; a group that believes they can lower the cost of healthcare for us in the USA
The last time you visited your doctor, chances are, you saw your doctor for a short period of time and either an RN or PA did the rest of the history and the workup. While physician extenders as they are called seem to be used more and more so practices can keep up with the volume of patients while keeping their ever tightening budgets in tact with fewer physicians, it appears that a group called nurse practitioners want to become unchained.
Nurse practitioners have a great deal of training with many common medical conditions and can give drugs such as antibiotics with the use of their own knowledge, rather than depending on a physician to ok the recommendation. Clinics such as minute clinic and others now use nurse practitioners to keep the entry cost lower since they work for lower salaries and likely have training that cost less and took less time too. This is not to say they are not qualified since a physician becomes a physician through an apprenticeship or as commonly known as a residency and internship.
While nurse practitioners have been around for quite some time, the medical profession would like to control them, as if they require a physician to function which they do not and their profession wants to break free. As a chiropractor, I can relate since we have been a direct access profession for musculoskeletal conditions for years, even though medicine through HMO’s have wanted to control access. Since HMO plans are no longer popular, more people experience the benefits and cost savings by visiting us directly. Nurse practitioners want those same rights and who could blame them; they are fully qualified to function in that capacity.
The question is would they save on the big costs, and would they refer to the right people. It is no secret that orthopedic offices are filled with people who needed rehab or a chiropractor and instead were sent to the orthopedic who then referred them on to therapy that was aimed at the painful part, but missed the problem entirely since you needed to evaluate the body and its mechanics to figure out problems like knee, foot and back pain appropriately. Nurse practitioners are still taught classic medical diagnosis which uses in the box thinking and flow charts and diseasafying problems based on the medical model. They will still order tests for painful problems that will be negative because they have little training in the musculoskeletal system, however, I also get the impression they would be more open minded on to whom to refer since they have been oppressed for so long.
Read the blog below, which brings up some interesting points. There is more to medical costs than just what someone is being charged at the primary care level. The problem is the paradigm which is outdated, broken and needs a revamp. A lowering of everyones costs or fees is not going to be that successful if the education and reeducation of physicians does not include better musculoskeletal evaluative skills and more openness to use more effective groups such as chiropractors without the previous bias and stigma.
Just last week, a patient visited us for a longstanding problem. The doctor from the walk in clinic looked at here and point blankly stated that he normally does not refer to chiropractors but knowing our work, stated here is one I can recommend. While I am aware that other chiropractors are quite good, are most doctors thinking that way preventing patients from getting more cost effective care? Of course, it helps that we have helped one of this clinic’s doctor’s for years with neck and back issues.
To truly fix healthcare costs, we need to reform the medical model, and look at people, not just the symptoms they came in with and then call it something while we throw a therapy at it hoping something sticks. This is why healthcare costs so much. Reform this, save a bundle. Then, after reducing the need for so many tests, many of the facilities that have overbuilt MRI and other diagnostics will feel the economic pinch and the prices will decline.
Check out this blog post.
Wonkbook: Doctors for higher health-care costs!
By Ezra Klein and Evan Soltas, Published: August 15 at 8:23 am
A crucial change in the health-care conversation over the last few years has been the shift in focus from “costs” to “prices.” Everyone knows American health care costs too much. But after the release of the International Federation of Health Plans’ data and Steven Brill’s epic Time article and the New York Times’ massive price series, it’s also becoming common knowledge that a major cause of those high overall costs is sky-high prices for every individual service, drug, and treatment.
Identifying the problem is easy. Doing anything about it is hard. But there’s one thing states can do that isn’t particularly hard: Allow more nurse practitioners — who charge much less than doctors — to treat patients directly, without a physician’s oversight.
Doctor’s groups oppose this strenuously. They say patient safety is at risk. What’s really at risk is their incomes. 17 states and the District of Columbia already allow nurse practitioners to treat patients directly and there’s been no resultant rash of patient deaths in Washington, Oregon, Maine, Colorado, Arizona, New Hampshire, Vermont, Rhode Island, Montana, Idaho, Nevada — I could go on. (Nor, by the way, has anyone heard of doctors going begging on the streets in those states, but I digress.)
The Wall Street Journal reports today that five other states are considering freeing nurse practitioners to practice with physician oversight, including California, where only 16 of the state’s 58 counties have enough primary-care doctors. These kinds of shortages are common, and they’re likely to get even worse as the population ages and the Affordable Care Act expands coverage to millions of Americans.