Get ready for Dr. Nurse, who will call himself/herself “Doctor,” but who, after 4 year bachelor’s degree in nursing, has gone to the Doctor of Nursing school for two years with a one year internship — that’s compared to the 4 years of college, 4 years of medical school, followed by at least 3 years of residency that Family Physicians, Pediatricians and Internal Medicine docs devote to training..
The Wall Street Journal reports (please let me know if you can’t access this page) that the National Board of Medical Examiners will begin testing these “DrNP” candidates this fall.
From the Wall Street Journal:
As doctors face shrinking insurance reimbursements and rising malpractice-insurance costs, more medical students are forsaking primary care for specialty practices with higher incomes and more predictable hours. As a result, there could be a shortfall ranging from 85,000 to 200,000 primary-care physicians by 2020, according to various estimates.
So,the supposed reasoning behind the new doctorate is this shortage of primary care doctors. That shortage has been artificially encouraged by all sorts of federal interventions. For some reason, no one’s considered paying Family Doctors more!
Instead, there are schemes to divide and re-divide the Medicare “Pie.” There are the rural health clinics, which are paid more by Medicare and Medicaid than your local family doctor, pediatrician or internal medicine doc for seeing the same patients. In order to qualify, the clinic — get the distinction, there, not the doctor, but who ever it is that owns the clinic and contracts with doctors and hires the rest of the staff – must hire at least one “mid level practitioner” to see patients. They can’t hire a doctor to do the same work and/or for the same money — they must hire a Physician Assistant or Nurse Practitioner.
As the article notes, the main reason for the loss of primary care physicians, however, is the low pay for the thinking part of what we do, compared to the procedures of specialists, such as all the varieties of surgeons, urologists, gynecologists and gastroenterologists. We analyze, examine and determine treatment or treatment change, resulting in “Evaluation and Management” visits. Rather than the codes used for procedures, the E&M visits are divided into levels of payment based on a set of check lists and diagnoses. The money from Medicare – followed closely by the insurance companies – has consistently shifted from the office visits toward the procedures.
Needless to say, the smart medical students — or at least the ones more interested in money than in your family history, living arrangements and whether Junior ate his peas and carrots will become interventional sub-specialists, not a Family Physician or Pediatrician.
A few years ago, Medicare payments increased for home health agencies, which encouraged RN’s and LVN’s to leave the hospital. Medicare quit paying your family doc to “scrub in” with the general surgeon or orthopedist as an assistant during your gall bladder surgery, colon resection or hip replacement. But, they did pay the surgeon enough to justify the hiring of a nurse practitioner or physician assistant. And studies said there was no difference or even better outcomes, since the “team” worked better in the Operating room and the peri-surgery procedure became more efficient.
(Of course, the NP or PA won’t be available to your wife or kids for questions next week, and won’t watch the effect of your new level of activity on your blood pressure or diabetes. And your family doctor may no longer even know that she should, since she won’t even find out about the surgery until your next visit or hospitalization. But that has nothing to do with the outcome of the surgery, right?)
The increase of Federal funding for Nurse Practitioners has exacerbated the loss of good RN’s and LVN’s – leading to more of the Federal pie going to nursing schools. And the DrNP will probably have the same effect. The WSJ article mentions the lack of faculty in the nursing schools. The funding will have to come out of the Medicare and Federal “pie.”
However, what patients need to consider is whether the DrNP training can truly accomplish the same training in 3 years that our Medical Schools can do in 5 to 7 years. Some have said that mid levels can handle 80% of what doctors do.
It’s that 20% that is the difference between knowing what you don’t know and planning for the 2 AM crisis.