A fourth of U.S. health visits now delivered by non-physicians
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Re: A fourth of U.S. health visits now delivered by non-physicians
#2Honestly I’m surprised the number isn’t already much higher. For at least the last 15 years most healthcare providers I deal with try to get you into a nurse practitioner or physicians assistant, and most have quite a few more of those than MDs and DOs.
Perhaps that’s a West Coast thing, though, and it’s not as common in other parts of the country?
Re: A fourth of U.S. health visits now delivered by non-physicians
#3Where I work we have a physician who doesn’t see patients. He reads procedures and supervises 8 mid-levels.
It’s an assembly line. There are inservices that in effect ensure maximum level of encounter complexity to maximize billing.
Re: A fourth of U.S. health visits now delivered by non-physicians
#4Honestly I’m surprised the number isn’t already much higher. For at least the last 15 years most healthcare providers I deal with try to get you into a nurse practitioner or physicians assistant, and most have quite a few more of those than MDs and DOs. Perhaps that’s a West Coast thing, though, and it’s not as common in other parts of the country?
MDs are limited in supply by the AMA. NPs and PAs are not, and for routine cases, sore throats, minor injuries, vaccinations, routine physical exams, etc. there is no reason an MD needs to be involved.
Re: A fourth of U.S. health visits now delivered by non-physicians
#5Because PA time is cheaper to the provider than MD time. Give it a few years and a trip to the doctor's office will mean using a touch screen a-la-mcdonalds to describe your symptoms and then the first-line medication pops out of a drawer.
I'm pretty jaded with our (US) healthcare system. As long as you stay on the happy path it's fine, but if you stray from that, good luck. Over the last few years I was given antibiotics for a gut infection, a lung infection, and currently a sinus infection. None were improved by antibiotics, but no doctor was willing to do a culture to see what the infection was before prescribing antibiotics because that's the happy path (most infectious are bacterial). I think it might be a systemic fungal infection (I've also had bouts of what I think is thrush), but that possibility is immediately rejected without investigation because 'only immunocompromised people get fungal infections'. Similar for SSRIs. Asked the shrink why SSRIs versus something else - 'got to start somewhere'. Asked them why one SSRI over another, same answer.
Throwing shit at the wall to see what sticks is fine if the cost of being wrong is just the list time of needing to recompile your code. It's 100% not ok when being wrong means fucking up your tendons or making you suicidal.
Re: A fourth of U.S. health visits now delivered by non-physicians
#6Honestly, I don't have any problem with this, and I see it as a great thing. 95% of the time when I go to the doctor it's something routine and basic, e.g. I just need someone to diagnose my cold/flu/infection etc.
My question, though, is where are all the "savings" going if so many visits are now seen by lower paid professionals? I was referred to a sleep study, where a PA or nurse practitioner just proceeded to ask me some basic questions from a form to see if I qualified for the study. She added practically nothing to the process (literally she was just reading questions from a form) and then charged my insurance company $200 for 15 minutes of her time. The whole thing was insane. That visit should have cost $20 max, yet people are lining their pockets at every step.
Re: A fourth of U.S. health visits now delivered by non-physicians
#7canadian anecdote: i havent seen my GP ever. He just oversees resident (student doctors). Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. Most of the time they deflect me from specialist care.
Re: A fourth of U.S. health visits now delivered by non-physicians
#8Honestly I’m surprised the number isn’t already much higher. For at least the last 15 years most healthcare providers I deal with try to get you into a nurse practitioner or physicians assistant, and most have quite a few more of those than MDs and DOs. Perhaps that’s a West Coast thing, though, and it’s not as common in other parts of the country?
MDs are limited in supply by the AMA. NPs and PAs are not, and for routine cases, sore throats, minor injuries, vaccinations, routine physical exams, etc. there is no reason an MD needs to be involved.
And for the routine stuff I often have a pretty good idea what's ailing me from past experience and I just need someone to write up the prescription again for whatever's worked well before. I have no problems with seeing an NP for that.
In some cases, an NP may have more current experience with figuring out the routine stuff than an MD who's a bit more removed from that kind of practice now.
Re: A fourth of U.S. health visits now delivered by non-physicians
#9Honestly, I don't have any problem with this, and I see it as a great thing. 95% of the time when I go to the doctor it's something routine and basic, e.g. I just need someone to diagnose my cold/flu/infection etc. My question, though, is where are all the "savings" going if so many visits are now seen by lower paid professionals? I was referred to a sleep study, where a PA or nurse practitioner just proceeded to ask…
That my insurer gives me significant financial incentive to see an NP at an urgent care clinic vs. going to the ER suggests the cost savings are translating into lower premiums, all else being equal.
Re: A fourth of U.S. health visits now delivered by non-physicians
#10Because PA time is cheaper to the provider than MD time. Give it a few years and a trip to the doctor's office will mean using a touch screen a-la-mcdonalds to describe your symptoms and then the first-line medication pops out of a drawer. I'm pretty jaded with our (US) healthcare system. As long as you stay on the happy path it's fine, but if you stray from that, good luck. Over the last few years I was given antibi…
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