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Politics : A US National Health Care System?
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To: i-node who wrote (6749)5/6/2009 11:37:35 AM
From: skinowski  Read Replies (3) of 42652
 
With regard to the Great Primary Care Debate.... I am beginning to envision more and more clearly that the solution may be a situation when each Internist works with and supervises 2-3-4 nurse practitioners or PA's.

My thinking is very simple. Nowadays, an Internist or Family Doc - between Medicare, HMO's etc. - when all is said and done receives probably about $60-70 per "cognitive" encounter. In order to be able to spend a needed amount of time with each patient - and pay expenses and still make living - this amount would need to be well over $100. This will not happen, since health care costs are perceived to be - and probably are - already higher than what people generally can afford.

That said, much of what a Primary Care Doc does is very simple. The treatment for many conditions, once properly diagnosed, is quite well worked out. There are more and more "evidence-based" treatment guidelines and protocols, and when used appropriately, for the most part they make sense.

An intelligent, intuitive and experienced nurse would be able to do quite well probably some 70-90% of what the MD does in a primary care setting - and there is no shortage of smart nurses out there. They'd probably be better at communicating with patients and families than a good many doctors.

I think it can be done. I think if I ever decide to go back into practice, I'd try to create a setup when 2-3 docs would work with - and supervise - a few times as many "mid-level" personnel.
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