Sarah Kliff thinks so, reporting in the Washington Post that the health care expansion envisioned in the Affordable Care Act will require an expansion of doctor supply as well. She outlines quite well the economic statistics involved and the currently-overwhelming incentives for young physicians to go into lucrative specialities. But there’s a 900-pound gorilla stomping all over the article.
Why exactly do we need primary medical care to be provided by doctors? Advanced practice nurses such as nurse practitioners often provide better care at a fraction of the cost. For many years I had a nurse practitioner as my primary care provider and still use one currently in most situations. As a friend of mine recently told me, “Nurses are patient-centric; doctors are disease-centric.” Well, when I become a disease, then I’ll see a doctor for my primary care. Note that I am not talking about any and all nurses, but rather only those who have advanced certifications — which are far less expensive to get than medical degrees.
What does the Post have to say about this possibility? Well, nothing at all. Not a single nurse is quoted in the piece. It simply assumes that we need doctors to provide primary care, and quotes the head of the American Academy of Family Physicians – which appears to have many of the characteristics of a trade group as well as a scientific and professional society.
Primary care doctors are great. It’s terrible that the incentives for young doctors to enter into specialities are so skewed. But while we are busy panicking and calling the fire department to put out a blaze, we might also want to think about picking up the hose next to us. The fact that we can’t even talk about this possibility suggests either a terrible lack of vision or physicians’ ability to artificially restrict the discussion. Or both.