03 March 2011

What's in a name?

Our school recently hosted a fascinating speaker discussing a number of health care policy issues with us.  One issue which really caught my attention is whether physicians should be calling themselves primary care providers.  We've all been told there is a shortage of physicians in areas like family practice, outpatient internal medicine and pediatrics at a time when these are the physicians our health care system is relying on to provide cost-efficient patient care.  This shortage is now being addressed by adding nurse practitioners and physician assistants to the primary care arena with a shorter training time and reduced compensation, all for the same results (I'm going to avoid the argument of whether the results really are the same).  Why should you pay a physician to give immunizations?  Any nurse can read a vaccination schedule and give you a shot.  Why would you want a doctor to treat your GERD?  In most states, PAs can write the prescription you need.  So what do physicians have to offer in primary care?

Part of the problem is the confusion between the individual mechanical activities of practice and the intellectual understanding of the mechanisms of disease, options for treatment, consideration of interactions and future consequences of disease and treatment. There is a level of care between primary (wellness checks, simple conditions, immunizations) and the tertiary care offered by specialists. This is the expanded role that physicians can cover which NPs and PAs do not and should not. These are the patients with multiple long-term diseases, the patients with conditions not yet controlled by medication and who are not yet sufficiently sick to need a specialist.  This is secondary care.  It is generally acknowledged that not all patients are going to need this level of care, but my personal preference as a patient is that I'd prefer to be treated by someone who is able to provide that level of care and not just a referral to a specialist.

The speaker's argument was that physicians are doing themselves a disservice by allowing or encouraging people to lump them together with NPs and PAs under the primary care title when it doesn't reflect the value and additional skills they bring to patients.  Something to think about.

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