September 21st, 2011 by Michael Kirsch, M.D. in Opinion
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All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.
We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan.
Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient safety standpoint, but there are powerful parochial issues worrying physicians. They are losing business. They have a point that Read more »
*This blog post was originally published at MD Whistleblower*
February 1st, 2011 by DrWes in Better Health Network, Opinion
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It came as a Twitter “follow” from @coldfeet65, a self-proclaimed “Nurse Practitioner Hospitalist.” I had never heard this term before. Does it mean a nurse practitioner who cares for hospitalists? Or is it a hospitalist who is a nurse practitioner? Or maybe it’s a nurse practitioner who helps hospitalists? (Honestly, I think I know which one she means, but you get my point.)
Perhaps this is a prescient glimpse to healthcare of the future, where our more typical nurse and doctor labels are supplanted by more and more monikers that serve to confuse, rather than clarify, each of our roles in healthcare delivery. As specialists in cardiology, we’ve seen a similar trend with cardiology hospitalists. But we should be clear what this means to the patients and doctors going forward.
No doubt most people in America still expect to see a doctor when they come to the hospital. Increasingly, it appears that might not be the case. Your doctor might be a robot while a nurse (aka, nurse practitioner) will be the one providing the hands-on care in the inpatient setting. Is that a good thing? Honestly, I’m not sure.
No one argues that the costs in healthcare need to be cut. No doubt the central authority has deemed that doctor salaries will be a big part of that effort. Already, 20 states have cut physician Medicaid payments for fiscal year 2010 and, given the current economic pressure on our states both now and after they start feeling the financial impact of the “Affordable” Care Act in 2019, this trend is not likely to improve anytime soon. As a result, we are seeing that the world is full of “creative solutions” to our healthcare access crisis and the evolution to “nurse practitioner hospitalists” might be one of these. Read more »
*This blog post was originally published at Dr. Wes*
January 24th, 2011 by Davis Liu, M.D. in Better Health Network, Opinion
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A recent post on the Health Affairs blog proclaimed “The End of Internal Medicine As We Know It.” What the post is really asking about is the future of primary care in the world of healthcare reform and the creation of accountable care organizations (ACOs). While doctors should be naturally concerned about change, I don’t completely agree with this article.
ACOs are organizations that are integrated and accountable for the health and well-being of a patient and also have joint responsibilities on how to thoughtfully use a patient’s or employer’s health insurance premium, something that is sorely lacking in the current health care structure. These were recently created and defined in the healthcare reform bill.
Yet the author seems to suggest that this is a step backwards:
Modern industry abandoned command-and-control style vertical integration decades ago in favor of flatter, more nimble institutions.
Not true. Successful organizations are ones that are tightly integrated, like Apple, FedEx, Wal-Mart, and Disney.
The author talks briefly about how Europe in general does better than the U.S. in terms of outcomes and costs and has a decentralized system. All true. However, contrasting Europe and America isn’t relevant. After all, who isn’t still using the metric system? Therefore solutions found outside the U.S. probably aren’t applicable due to a variety of reasons. Americans like to do things our way.
What I do agree on is that doctors need to be part of the solution and ensure that the disasters of decades ago — like labeling primary care doctors (internists and family physicians) as “gatekeepers” rather than what we really do — never happen. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
May 19th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Research
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What if some physicians actually like the way primary care is currently practiced? It’s hard to believe, considering the majority of studies suggest marked dissatisfaction among primary care doctors, and an increasing prevalence of physician burnout.
The ACP’s Bob Doherty recently summarized an epic Health Affairs article devoted to fixing primary care. The bottom line was that paying primary care doctors better isn’t enough. The whole field needs to be re-invented. Read more »
*This blog post was originally published at KevinMD.com*
May 5th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Policy, Opinion, Research
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The new healthcare reform law, which is called the Patient Protection and Affordable Care Act (PPACA), will be a huge disappointment to the millions of previously-uninsured people who finally purchase insurance policies when they try to find a doctor.
Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come calling. Who is going to be available to treat them? Read more »
*This blog post was originally published at EverythingHealth*
All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.
