Ending the “Doctor Shortage”

We Americans do not have the world’s “best” health care, just the most expensive.

Health Care reform must consider skyrocketing costs if any progress is made. We walk a tightrope between cost and quality.

When I slung gin over the bar, one learnt rather quickly from frazzled nurses that “M.D.” too often stood for “Me, Doctor!”  The human body is a complex beastie, but we need choices other than which expired medico to raise from the dead, Dr. Christiaan Barnard, the South African who performed the first successful heart transplant in 1967, or Dr. Jack Kevorkian, the euthanasia guy. Make no mistake about it, physicians provide a vital service, and deserve to be well compensated for their education, experience, and the risks they take.  We have, however, priced ourselves out of the market with this “personal physician” schtick. We don’t go to the CEO of Goldman Sachs for a car loan.

navydocFor many maladies, we really don’t need the skill set we are currently forced to try to afford with a fully qualified physician. We already have heard that there aren’t enough physicians in many communities as it is. Fee-for-service and the doctor monopoly are unsustainable.   There is a viable alternative between the actor-physician on television and browsing the barnyard castration implement aisle at the farm store.  At-home anesthesiology and minor surgery are also tricky affairs with a bottle of Jack Daniel’s Tennessee Sour Mash Whiskey (“Same as our fathers made it.”) Nurse Practitioners and Physician Assistants can fill the void, and already do in many practices. We just need to pry loose the physician’s profiteering death grip on their use.

In a system where everybody is a “specialist” of one sort or another, billing out at rates which match, it’s not just the dog-and-cat-possessed who would long to see their Veterinarian instead.

Back in the so-called “good old days” as a sailor and later a naval officer, it was a big deal seeing a physician. Unless you were the Rockefellers, or Admiral of the Fleet, there was a triage system which matched healing resources far better than the current fantasy of a “personal physician.”  One would have been seen first by an enlisted corpsman, a nurse-practitioner, or physician assistant in the mostly routine cases. Submarines and small ships were served by a trained independent duty corpsman rather than a full-blown M.D.. Somehow we survived.

I still fail to see any positive benefit from insurers for anyone other than their corporate officers and shareholders. Certainly not good for us. I still remember the exasperated Health Management Organization (HMO) doc a couple of decades back who let it slip that HMO stood for “Health Mangling Organization.”

Empowering more independent nurse practitioners and physician assistants could help rein in America’s ballooning health care costs while maintaining quality. Once we pry the physician lobby from micromanaging the controls, these other trained professionals would stay within their brief, enhancing access to qualified health care at more moderate and sustainable cost.  Physicians would receive pre-qualified referrals from nurse practitioners and physician assistants who knew the limits of their practice.

As we hear conservatives bemoan public sector unions, there’s nary a peep about the health care lobby which maintains the pricy physician, or heaven forbid, insurance, cartels.  There is an incredible depth of experience and capability in our health care system, if only we would use it.

What we have isn’t sustainable.