from the article:
California came up with a proposed solution. Change the definition of a doctor.
[Lawmakers] are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.
This was discussed on a panel of moderator and two other people today on cable… The moderator asked “.. would you want a Pharmacist – from CVS – doing your next health exam..”? Everyone came up with the same answer NO !
One of the two commenting husband was a orthoped surgeon..
The discussion seem to hover around the fact that ARNP, PA, NP were already doing this in the physician’s office.. it was OK!
While not a scientific survey.. the agreement of all three … may be representative of the majority of the population.
Could the negative reaction be more of the retail environment that the Pharmacist typically works in… as opposed to a more medical office setting?
Could Pharmacists be accepted by pts in over seeing their health management?
For those who are predicting that Pharmacists will be working with collaborative agreements with physicians and pharmacists being geographically separated … be off the mark .. as to what the general pt population will accept?
Filed under: General Problems
As a kid, my dad was a graduate student and my mom was a stay at home mom by choice. We didn’t have insurance or Medicaid( my mom said we qualified for Medicad, but they refused to apply for it). I remember my parents paying outright for all the medical bills. I remember my parents only took us to the doctor when it was necessary…not for every single sniffle, etc. When I got into pharmacy in the late 80s, it seemed suddenly everyone had only copays and the chain store I worked at went from maybe 100-150 rxs per day to well over 400 overnight. I noticed suddenly since it was either ‘free’ $2, or $5, it was all about getting as much at they could on their meds for that price. In the early days of “HMO and Managed Care’ , some of these plans in my area, didn’t have a ‘days supply’ limit…I had customers wanting to get a years supply for 5 bucks! People then started running to the doctor for every single sniffle “cause it’s only 5 bucks for the visit”, no personal responsibility, no even thinking…’Is a doctor visit even necessary?” I dread what’s coming with ObamaCare. I also see rationing, long waits for treatments, and very very few new drugs because the incentives for research will no longer be there. Yes, we more than likely need to go back to paying cash and definitely tort reform. And sometimes I wonder if it’s even worth the time and the money to continue to try and force very non compliant chronic disease patients to take their meds..but I think that’s another discussion
It is really a sad commentary on the looming future of healthcare. Patients will be visiting ‘half doctors’. Physician assistants and nurse practitioners are no replacement for physicians. That would be the equivalent of turning pharmacies over to techs. Evidently there is something wrong with the educational system and/or the motivation of students to become physicians. Look at the number of students pouring into the pharmacy schools and the growth of pharmacy schools. Why is this not happening with physicians? The author of the article makes a good point: if people can become nurse practitioners and physician assistants, and then be classified as ‘physicians’, then why would anyone want to go to medical school? Nurse practitioners and physician assistants have their place; however, they are not a replacement for a physician. They do not have the education of a physician. Suppose you turned over your pharmacy to a tech. The tech would make all the decisions. What about DUR overrides? Is the tech going to know what is significant and what is not? Of course not. I would say that it might be possible, through technology, to expand the expertise of NP’s and PA’s. But, with what I have seen so far with technology, it looks like it might just cause more problems than it solves. E-scripts is a prime example of technology gone wrong. There is another looming problem on the horizon in healthcare: the cost of drugs. We are seeing just a bit of a coming ‘salvo’ of drugs that are very expensive. Take for instance Bydureon. It is about $300 per vial. Most insurances require a PA. Bydureon, like a number of other drugs, such as Forteo, are almost in a class all by themselves because of their expense. We will see more and more drugs like these. But, who will pay for them? I would not be surprised to see even more ‘super’ drugs that are in a class even more expensive than these. Yes, I know some of you can give examples. There are, and will be more, drugs that are $10K and up. Will we see drugs $100K and up? My point: the ‘degree’ or ‘quality’ of healthcare comes with a price. It is impossible for our society to pay for the most sophisticated drugs for everyone. The current method of payment is by insurance and as the cost of healthcare increases so do the premiums. But, the insurance companies are about to price themselves out of the market as more and more people cannot afford it. Obamacare is not going to solve this problem. As government gets more and more involved in healthcare, there will be increasing cuts to providers and the exodus of providers from the healthcare system. And, government will be forced to ‘limit’ healthcare. Those expensive drugs will no longer be on the list to be paid by government. We are going to have a system much like England. There will be waiting lines for treatment and long delays for surgery. More people will have healthcare provided to them, but it will be lesser in quality. There is no way around this problem. This is what we are seeing in California where they are talking about labeling NP’s and PA’s as physicians. The state will be providing more access to patients but at a lower quality.
I could write a long dissertation on more of what is wrong with our healthcare system and I could provide alternatives. There are alternatives to the problems we face. And, at some point, we may have to face and embrace those alternatives. Currently, the psychology of the country is bent on government providing solutions. I don’t believe government will be the solution, and will in fact be much of the cause of the problem. There is a mindset that a complex healthcare system must be ‘centralized’, ‘controlled’, and ‘directed’ by government. This is entirely wrong! There is a mistaken view of complex systems. A complex system does not have to be ‘controlled’. It can control its self. That may seem like a crazy statement. But, it is in fact true. What if each persons healthcare was their own responsibility? Suppose every person had to pay in cash for their healthcare? The whole healthcare system would change over night. It would become more streamlined…more efficient…more cost effective. As it is today, government bureaucrats, insurance companies, and PBM’s are gobbling up a huge chunk of healthcare dollars. Look at the costs of just billing insurance companies? Look at the costs of billing the government? Take out all these middle people! They don’t serve any purpose other than gobble up money. You will say: what about people that cannot afford healthcare? They will get less healthcare provided to them. But, what is the alternative? The same path we are traveling today and the path that is going to lead to lower quality healthcare for all? At the rate we are going, providing healthcare to the entire American population is going to lead to total bankruptcy of the country and a total collapse of government. Just look at pharmacy today. Look at the time involved in getting payment for a prescription. It often takes more time to get the payment than it does to fill the rx. This is ‘bureaucracy’ and the very thing that eventually just ‘clogs’ a system and leads to its collapse. The old Soviet Union is a prime example of this type bureaucracy.