America is already experiencing a shortage of doctors. The expansion of the Affordable Care Act (ACA) to millions of uninsured Americans will make that shortage even worse. Certainly expanding medical schools in residency program send training more physicians could help in the long run, however, this is not going to solve the problem in the very near future.
A reasonable solution to fix the acute shortage of primary care physicians is to rely on nurse practitioners, physicians assistants, pharmacists, and even patients to do the routine tasks traditionally reserved for physicians.
Some examples to consider: The American pharmacist is under-utilized given their education, training and their closeness to the community. Pharmacists are capable of starting, stopping or adjusting medications and interpreting laboratory tests and even coordinating followup care. However, at the present time state and Federal laws make it hard for pharmacists in private practice to perform services without a doctor’s supervision.
Nurse practitioners. 18 states and the District of Columbia allow a nurse practitioners to diagnose illnesses, treat patients, and to prescribe medications without doctors involvement. There is ample evidence that nurse practitioners are as capable of providing primary care as doctors and are generally more sensitive to what a patient wants and needs.
Retail clinics. hundreds of clinics, staffed by nurse practitioners have been opened in drugstores and big retail stores around the country putting basic care within easy reach of millions of people. It has been documented that retail clinics provide cheaper care than doctor’s offices, urgent care centers and emergency rooms.
Self-care. Patients with chronic diseases such as hypertension, diabetes and congestive heart failure can decide whether they want a care coordinator to visit them at home or prefer to measure their own blood pressure, pulse or glucose levels and enter the results online where the data can be reviewed by their primary care physician. The patient could consult by phone or e-mail with a nurse about medications, diet, and need for followup care.
The Affordable Care Act contains many provisions that should help relieve the shortage of primary care providers. If we continue to practice medicine in the standard fee-for-service fashion that we have done in the past, we risk falling off a healthcare cliff. Perhaps giving more authority to pharmacists, nurse practitioners, and even allowing patients to take a greater role in their medical care is a move in the right direction.
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