North Bay Business Journal

Wednesday, May 1, 2013, 12:20 pm

Share your thoughts: Mid-level health care providers help the doctor shortage?

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    NBBJ Pulse Poll

    Do you think physician's assistants, nurse practitioners and other mid-level health care providers can shore up the projected primary care physician shortage?

    • Yes (38%, 34 votes)
    • No (61%, 54 votes)
    • Don't know (1%, 1 votes)

    Total voters: 89
    Polling period: May 1, 2013 @ 12:00 pm – May 8, 2013 @ 12:00 pm

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    More to say? Leave your comments below.

    As the Affordable Care Act looms large on the minds of health care providers, lawmakers and providers are increasingly calling for less stringent limitations on nonphysicians in order to meet demand spurred by the forthcoming influx of new patients.

    In the past three months, a spate of assembly and senate bills have been introduced to address the matter. State Sen. Ed Hernandez, D-West Covina, introduced a set of bills — Senate Bills 491 through 493 — that would expand practice areas for a number of nurse practitioners, pharmacists, certified nurse midwives and optometrists. A separate bill by Sen. Fran Pavley, D-Aurora Hills, would do the same for physician assistants.

    Meanwhile, a host of physician advocacy groups unveiled their own set of bills that would address California’s well-documented primary care physician shortage without loosening restrictions on nonphysicians, among them Assembly Bill 565, which would expand a student loan repayment program for physicians who practice in medically underserved areas; AB 1176, which would create more residency slots in underserved areas by way of insurer fees; and AB 1288, which would place a priority on applications for physicians who practice in medically underserved areas.

    The two approaches reflect long-running debate between physicians and non-physicians, although it’s less contentious than it has been, local health care experts said. [read more in "New proposals seek to address level of non-physician care"]

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    1. May 2, 2013, 2:11 pm

      by Californians for Patient Care

      SB 491, SB 492, and SB 493 will help millions of Californians gain access to safe, high quality and affordable healthcare services when needed.

      Under the ACA, about 4.7 million more Californians will be eligible for health insurance starting in 2014. About 1.4 million will be newly eligible for Medi-Cal. However, there are not enough trained medical professionals to appropriately care for these new patients.

      SB 491, SB 492, and SB 493 would allow qualified, educated and trained nurse practitioners, optometrists, and pharmacists to practice to the full extent of their licenses. This would benefit all of California’s patient population, especially those that live in rural communities.

    2. May 2, 2013, 9:44 pm

      by Heather

      I would just like to point out a few vocabulary issues. The the term “Mid-Level Provider” is not appropriate for NPs. NPs are at the top of the Nursing profession — not in the middle. Physicians are not at the top of some sort of hierarchy of healthcare providers with NPs below them. NPs and physicians are different professions entirely.

      Also, please use the term “physician” when referring to medical doctors. The term “doctor” applies to a broad range of individuals — anyone with a PhD or a practice doctorate (JD, PharmD, DNP, etc.). Medical doctors should not have a monopoly on that term.

    3. May 5, 2013, 7:40 am

      by Carlos

      I do not like the idea of allowing mid level providers such as nurse practitioners to provide unsupervised care. Nurse practitioners as a profession were developed in the 1960s to be “physician extenders”, so that they can provide care under supervision of more qualified physicians. This is not a point of elitism, it’s just that physicians have 21,000 hours of training and nurse practitioners only have 3,000-6,000, not to mention their training doesn’t involve a residency training program.

      I feel like the best way to maximize the benefits of the affordable care act is to have physician led teams led by highly trained physicians and under them mid level providers such as nurse practitioners. It’s quite disturbing to me that nurse practitioners are demanding to go beyond their training and scope of practice and jeopardize patient safety just because they want to make an extra buck. Instead of creating a two tiered system of healthcare where the poor and elderly only have access to the much less trained NPs, we should really push for the healthcare teams.

    4. May 10, 2013, 7:16 pm

      by Tino

      The aforementioned senate bills are not being introduced so that Nurse Practitioners can “make an extra buck”.

      The ACA will be increasing the number of MediCal eligible patients seeking primary care. As someone who has worked in a local community clinic that served this patient population, I can say that nobody was in it for the money, and everyone (both patients and providers) would likely welcome the added flexibility to serve patient’s needs. The true jeopardy to patient safety is when we preclude patients from getting timely care because of limited access. Stonewalling innovative ways to increase care options is a more obvious risk to patients.

    5. May 13, 2013, 10:10 pm

      by Mike Smith

      I’m also skeptical of the motivation of these senate bills. It’s understood that there is an access issue after the passage of the affordable care act because there is a shortage of physicians.

      However, a reasonable response would be to immediately increase the number of physicians being trained and increase the incentives for physicians to practice in low income areas. California has done little of this for an obvious reason, money! California has historically sacrificed good quality care for cheaper care, especially for those most vulnerable — the poor and disabled. Allowing nurse practitioners and other mid level providers to practice independently is attractive for states because nurse practitioners are cheaply and quickly trained, and therefore will accept substantially lower reimbursements for their services.

      This, however, comes at a cost because they can’t possibly in any way have the deep understanding of disease pathology as physicians do. Sure, they can follow cook book medicine using algorithms to treat ailments, but many people today have complicated conditioners, pathologies affecting multiple organ systems. We need physicians to treat and manage these people’s illnesses. Nurse practitioners and other mid level provider organizations are understandably pushing for these bills because they stand to make a lot more money than they are currently making. The affordable care act pores billions of dollars into primary care and there are a lot of people salivating of the possibility of getting those dollars and are more than willing to sacrifice the quality of patient care for those dollars.

      I agree that it’s sad that our medical system is moving toward a walmart style system where the poor go to walmart to see their nurse practitioner instead of their family physician. I thought the affordable care act will provide everyone with quality care, not just cheap and convenient care at the expense of quality. I think these bills are not only morally wrong, but since it involves peoples’ lives I would even go as far as to say they are criminal.

    6. May 14, 2013, 5:43 am

      by Jerry Wilson

      Allowing nurse practitioners to provide care independently as primary care providers is a cheap and convienient way out for the states, but it will lead to a two-tiered healthcare system. Instead, we should start now making the investments we need to recruit more good quality physicians, even if it means we have to spend a little more money. There is nothing “innovative” about cheating the poor out of access to a physician.

    7. May 14, 2013, 11:33 am

      by Jessica Rose

      “Flexibility”! I’m have medi-cal and I can tell you I have no flexibility. There are no physicians who will take my insurance, they say the reimbursements are way too low. I don’t blame them for wanting to make money, but when I complained to Medi-Cal, they responded saying I have great access to health care providers other than physicians. These senate bills are a way of further restricting my access to a doctor because they don’t want to pay a doctor. People in other states like Wisconsin don’t have this problem where 99% of doctors accept medicaid because reimbursements are fair.

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