As Obamacare draws millions of previously uninsured Americans into the healthcare system, the shortage of physicians will become increasingly acute. So who will care for this avalanche of new patients?
State laws restrict the practice of medicine and those who are allowed to prescribe medications to licensed physicians. This may be changing as states expand the role of non-physicians.
Dr. Amesh Adalja, a quadruple board-certified physician notes that for many conditions, a nurse practitioner may begin to fill the gap. Using non-physicians to provide care in certain instances provides increased access to healthcare and may even reduce the cost of healthcare.
Predictably, physician trade associations have expressed their opposition to this physician-independent practice of medicine. Limiting medical practice to only state-licensed physicians limits a patient’s healthcare choices, forcing patients to opt for the costlier services of a physician. Yaron Brook and Don Watkins, authors of a Free Market Revolution, feel that the current physician licensing laws are simply “a way to establish an anti-competitive guild system.” The system is kept alive by laws that tout patient safety and by physician-paid fees to state medical boards to the tune of $6.5 billion a year. While medical boards certify physicians, these certifications don’t guarantee a physician’s proficiency. This is why hospitals and third-party payers frequently insist on additional qualifications before hiring a physician or paying for care at full rates.
Expanding a nurse practitioner’s authority to treat patients has been opposed by the American Medical Association (AMA), the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association, which all support direct supervision of NPs by physicians.
Physicians may have to give in as Obamacare kicks in. "That horse has already left the barn," says Linda Aiken, professor of nursing at the University of Pennsylvania School of Nursing and director of the Center for Health Outcomes and Policy Research. "With Obamacare coming in and millions of people getting insurance, there is no other way to provide them with reasonable access in the short term except to expand the role of NPs and physician assistants (PAs). It takes 20 years to train a doctor, so there isn't any alternative."
Clearly, a physician’s expertise and training is preferred for complicated medical conditions. That said, other simple conditions could be as effectively served by a physician’s assistant, a nurse practitioner or a nurse midwife.
While the government should “watchdog” physicians who defraud patients or materially misrepresent themselves, it should limit its role in the provider-patient relationship. This means allowing patients to seek the help of a physician’s assistant or nurse practitioner, without being hamstrung by unwieldy licensing laws and guild-minded state government medical boards.
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