There is a shortage of doctors providing primary care in the United States. No matter how you look at the statistical projections of the growing population and the growing proportion of us who will be older and bear a greater burden of chronic disease, it is clear that we will need more doctors. And, no matter how you look at projections of the supply of doctors, and especially those providing primary care, it is clear that the supply will fall well short of demand.
Explore This IssueACEP News: Vol 31 – No 11 – November 2012
A colleague of mine recently sent me an article from one of the leading trade publications outlining the many reasons today’s physicians find the practice of medicine frustrating and stressful, including ever-increasing and time-consuming government regulations that are seen as mostly inane and useless. The other major stressor is constant worry about being sued any time there is an adverse outcome. We live in a culture of blame, and when a patient experiences an adverse health outcome, the finger of blame will naturally point at his doctor.
So, at just the time when we need more doctors, today’s physicians are less satisfied with their work, which means they are deciding to work less, retire earlier, and dissuade their offspring from choosing this profession.
Perhaps, as a society, we should be trying to reverse the trend and make the medical profession more attractive. But wait. There is another possibility. Physicians aren’t the only ones who can do this job. There are nurse practitioners. They can do many of the things doctors can do in primary care. They will work for less money. What a deal!
If someone can do a job as well as the last person for less money, that has great appeal as a “value proposition.” And the value proposition is important in healthcare when the percentage of our GDP that we spend on it has reached the high teens.
So what about nurse practitioners in primary care? Do they do as good a job for less money?
To answer that question, we need a lot of data. We need data on costs and outcomes. And we need data on outcomes both short-term and long-term. I’ll come back to that in a bit.
If you have a cold or a sore throat and go to a retail clinic or urgent care center staffed by nurse practitioners, you will probably get a lower bill than if you went to see a doctor. That suggests a favorable value proposition. But sometimes things are not simple and straightforward, and sometimes you need someone with a deeper understanding of your problem.