Obamacare, shortage of doctors, will lead states to give more authority to nurse practitioners

Back in November 2009, I pointed out an article in the Wall Street Journal about the coming physician shortage in the United States. The post noted President Obama’s health care legislation did nothing to deal with the issue, that could result in a shortage of 125,000 doctors by 2025. The shortage is still mentioned in the media, and I’m surprised I did not figure out the solution … change the definition of a doctor.

Yes, I did bring up this idea in February in reference to an article about California, but it deserves a review. And yes, I did put Obamacare in the headline because this has been a known issue – a real issues – for years, and Congress and the president refused to deal with it in their legislation. From the AARP Blog.

Let’s do the math: We have nearly 30 million uninsured people about to get medical coverage under the health care law come January. And we have a projected shortage of 45,000 primary care physicians by 2020. Add to that the American Association of Nurse Practitioners (AANP), with 43,000 members who say they can offer basic care if state laws would just let them set up an independent practice without doctor supervision.

And the answer is …

The nurse-practitioners, of course, say it’s a matter of simple addition: New laws are needed to give them more autonomy.

I’m certain that nurse practitioners can do a very good job treating people some of the time. But what is the level of training they get as compared to a doctor?

Family physicians have more than four times as much education and training, accumulating an average of 21,700 hours, whereas nurse-practitioners receive 5,350 hours, the American Academy of Family Physicians points out.

Trained physicians, hospitals and nurses make hundreds of thousands of mistakes, leading to thousands of patient deaths each year. There are probably only a few thousand cases each year brought to a jury and a minority of those cases are won by the plaintiff, but the monetary awards are high. Physician malpractice insurance is not expensive because insurance companies think they can get big premiums from rich doctors, they are high because the damage awards and costs to defend are high.

That said, how many more mistakes are acceptable? Will nurse practitioners be required to carry malpractice insurance? How much will those premiums cost? Will the suggestion that nurse practitioners take up the slack simply lead to a shortage of nurses? To me, it certainly seems this solution would eventually make the problem worse … unless of course we do not require nurses to have malpractice insurance. In other words, the suggestion to give nurses more authority is treating a symptom instead of the disease.

There are many reasons why there is a shortage of physicians in the United States. New doctors know they will be squeezed by high school loans on one side and high insurance premiums on the other. It’s hard to do and takes a lot of time. We should not be taking a band-aid approach that will lower quality. The Wall Street Journal post in 2009 mentioned…

To address the shortage of doctors and the incentives that compel young doctors to eschew primary care, Congress needs to think about how to increase doctor pay, institute malpractice reform, and provide subsidies to reduce the amount of debt doctors have to take on. Residency caps should also be raised so teaching hospitals can train more doctors. Without these actions new doctors would be foolish to enter primary care, and thankfully our medical schools do not recruit foolish people.