[quote]Professor X wrote:
[quote]MaximusB wrote:
[quote]Professor X wrote:
[quote]MaximusB wrote:
[quote]Professor X wrote:
Come on guys…read the fine print before loading the rifles.[/quote]
Right, because I want the supervision of a physician, rather than their treatment.
This kind of mentality is going to usher in a third world style of healthcare.[/quote]
Wow…you mean like in every dental and medical school across the country?
All it does is mean your practicing assistant with experience (who may be a woman) can do this as well as the doctor with the doctor standing there.
No “third world style of healthcare”. They do this everyday across the country and all it does is reduce fees for the patient.[/quote]
Then by all means you can be the first up to receive this type of healthcare.
I will sit back and observe, right next to the real physician. [/quote]
Lol.
In reality it now means one doctor can supervise several procedures at once increasing productivity and decreasing cost.[/quote]
“Decreasing cost?”…meaning “cheaper”…hmmm.
No. The cost may (or may not, as we shall see) be less, but only if one is buying the same service or product.
I argue that is not the case, and I offer a recent example:
Last Monday, a woman in her late 40’s saw me for a routing scheduled visit. She had early breast cancer and was without disease for 2.5 years. After a careful review of systems and interval history, she told me that 3 days previously she had had a single headache which awakened her from sleep. She was without any other headache, fever, stiff neck or neurologic complaint. I took a social history; her two teenagers were without any illness or headache, fever or diarrhea. On my exam, she was without fever, the eye grounds were normal, there was no meningismus (neck stiffness) or any other neurologic or other complaints. At this point she was at very low risk for cancer recurrent in brain or meninges, and there were no findings to support meningitis. (If she had had bacterial meningitis, she would have been dead by then.) I asked her to call if headache recurred.
The next day, she called from her car saying that she had recurrent headache–no fever of stiff neck–and now had abdominal pain. The differential diagnosis now included shingles or enterovirus with viral meningitis; I asked her to go to the ER where I would re-examine her. Instead she went to her primary care doctor, elsewhere. She was evaluated by a Nurse Practitioner. Later, from her hospital bed, I determined that no physical exam was performed, but at the ER she had scans, an LP, and–long story short–she was later confirmed to have herpes simplex II meningitis. Note, please, that the Nurse Practitioner may have reported to her physician, but the physician never conducted an exam either.
The point is not that I missed a diagnosis in a minimally symptomatic patient, but that “under the supervision of a doctor” she in fact never got a doctor to examine her.
Was this the same service as a doctor’s exam? No. One can’t argue that the exam was deferred to an ER doctor, since it used to be the case that I saw the patient, looked in the eyes, and did an LP myself. The hidden costs here are extraneous use of the ER, scans (which everyone would now do out of fear of lawsuits), etc.
So then, we are now buying into the speculation that NPs can perform “under the supervision of a doctor” and provide the same acute care service at less cost, and thereby increase productivity. This has never been proven–with the possible exception of nurse anesthetists–and it ignores the proposition of hidden costs. There is clear evidence to the contrary: every study for decades has shown that for similar degrees of acuity, the cost of medical care in teaching hospitals is measures greater than in non-teaching hospitals. Hence, “physician extenders” or “staff in training” do not necessarily reduce costs but raise them.
The fascination with physician extenders is promoted by insurance companies in routine evaluations and is a trick of ledgering; the insurance company believes more services are being done with a cheaper resource than a physician, whereas the reality is that the costs disappear from the insurance company into the physcian’s overhead costs.
Writ large, whether in California by law or nationally by the pressures of Obamacare, it is not at all clear to me that we are buying the same service at a cheaper price or with better outcomes.