"Well... it depends on the physician's personality, willingness to share the care of his or her patients, ability to trust the person to treat and manage medical patient's problems properly, afford to hire a higher level of provider, and accept the extra time and efforts to supervise or instruct the healthcare provider."
By 2022, All physicians in private medical practice management are well versed in the functions of midlevel providers. As far back as 1970, when my Kaiser permanente nurse applied for and was accepted for the new nurse practitioner education and training program in the Bay Area, we have all watched this segment of healthcare providers invade medical practice areas and has continued to increase since. The medical care laws were faced with two serious issues which had to be resolved. Could a midlevel provider be trusted? Do midlevel providers need to be supervised?
The medical doctors outrage about letting any partially trained healthcare provider actually being allowed to independently treat medical patients took years to dissipate. First, they never received all the training and knowledge physicians had to be doing the same things physicians do. Second, they were not capable of handling the consequences of their medical treatments or even making proper diagnoses. Third, they would likely miss other serious medical problems that
physicians wouldn't.
The event that changed the physician's perspective came about by the fact that midlevel providers filled in the vacancies resulting from the serious need for more physicians in our country. Eventually it became obvious that midlevel providers made very few mistakes in medical practice management of patients and that they were good at medical management of minor medical issues patients had that physicians considered a poor use of their time and skills to treat. It helped take a load off of the physicians shoulders best of all.
The second issue of supervision was the most threatening to physicians and medical-legal authorities. It started out being a requirement of supervision of all midlevel providers. That requirement was abused so much and so often by the physician supervisors without any serious problems, that essentially all mid-level providers carry on their duties independently. Usually they work close by a physician and assumed to be being supervised.
Physicians discovered that supervision of midlevel providers required way too many interruptions of their own medical care of patients treatment time that they couldn't tolerate the supervision. By then, physicians had learned that they could trust the mid-level providers, except for a few that always ask questions or advice. Who cares what the law says now!
About those mid-level healthcare providers...
- Midlevel providers (NPs, PAs, CNMs, and Administrative Nurses) are being happily jockeyed into much more medical practice business responsibilities that they have struggled to gain for years. First, medical practice laws that have been on the books will have to be revised to a significant degree to allow these medical care providers to be legally protected, and to expand the extent of what they are allowed to do, or get away with at times.
Second, medical malpractice laws have to revised to a considerable extent. If these midlevel providers will be increasing their risks for newly allowed procedures, two problems will arise for physicians.
1. If mid-level providers are required to remain under the casual supervision of physicians and permitted to do much more in medical care, the physicians who supervise them will be at higher risk and malpractice premiums will need to be increased proportionally.
2. If there are less medical doctors as the attrition of doctors continues, then the need to increase the use of midlevel providers will be necessary, more physicians will have to be involved and a larger number of physicians will be at higher risk in the process.
- It's unlikely that midlevel providers will be allowed by law to work independently, but I sure would not rule that out and maybe already is available under some state medical-legal statutes.
- Need for increasing numbers of sub-specialized physicians will be necessary because primary care will basically be managed by midlevel providers. Medical care problems outside the capability of a midlevel provider will be referred to specialists. In order for these specialists to financially survive, get enough referrals of patients, they will have to become subspecialists that manage only certain medical conditions within their specialty.
For example, it would be logical that CNMs (Certified Nurse Midwife) would manage 80% of all OB care, so OB doctors will choose to do only C-sections, and a segment of infertility care such as microsurgery tuboplasty, IVF, infertility counseling.
GYN doctors would train separately and practice separately from OB care. Even they will need to sub-specialize in gyn segments of the specialty.
- You probably are aware that building new medical schools will be a rare event, and that the 174 accredited USA medical schools have no intention to enlarge their enrollment. So where will the increasing numbers of physicians going to come from to take care of our rapidly expanding population that we already have a shortage of. But, there are many non-accredited medical schools.
Well, import more foreign doctors, make their licensure easier, because the educational costs for medical education have reached the limits affordable for over 90% of the American students. Governmental grants and scholarship aid debts for students is already at a trillion dollars with most now in default status.
- Soon, the chore of recruiting American students will be overwhelming if it isn't already. Now you see up to 25% of medical school classes are foreign students. I wonder how soon they will have no American medical students in their classes? Perhaps the progressives planned it all that way--you know... the World Order. That ought to solve the medical care problems... right?
- All medical doctors and other "doctors" will be employees of some agency, facility, hospital, governmental dept., or who knows what.
- Private medical practice will not be an option in 5 years, with rare exceptions such as a "cash only" medical practice. I expect that the departure of medical doctors already in private medical practice will increase substantially in the next 5 years--already has been.
- I detest the thought that doctors will be forced to work and practice under restrictions to medical practice from a non-medical boss or CEO. What I have noticed is that a great number of my medical school classmates who have spent their careers within the umbrella environment of medical education systems, large university hospital teaching centers, and places where medical education and training is involved, have come through their careers of being employed, or contracted positions, feeling quite satisfied with themselves.
That might be a good place to move into if possible, and if you don't plan on retiring early. It draws those who need security and mothering, it has been said.
Your efforts to handle your next 10 years in medical practice will be far more difficult than graduating from medical school and far more stressful. If you watch TV programs, you may well know the show, HOUSE, where the doctor is an addict and a renegade, but brilliant minded. House himself, may be a model for the next generation of medical doctors should the medical profession become robots, taught to practice medicine using hundreds of protocols from which no deviations are allowed, and creativeness becomes non-existent.
----Professional Probe----
"We may be close to the time when all
physicians and mid-level healthcare
providers will become government
employees, sad to say."
Articles © 2013-2022/CGG INVESTMENTS LLC. All rights reserved. #30, 3-16-22
