Everyone is entitled to his own opinion, but not his own facts. Founded by Mark Kleiman (1951-2019)
Do We Really Need 30,000 More Primary Care Doctors?
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.Â She outlines quite well the economic statistics involved and the currently-overwhelming incentives for young physicians to go into lucrative specialities.Â 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?Â Advanced practice nurses such as nurse practitioners often provide better care at a fraction of the cost.Â For many years I had a nurse practitioner as my primary care provider and still use one currently in most situations.Â As a friend of mine recently told me, “Nurses are patient-centric; doctors are disease-centric.”Â Well, when I become a disease, then I’ll see a doctor for my primary care.Â Â 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?Â Well, nothing at all.Â Not a single nurse is quoted in the piece.Â It simply assumes that we need doctors to provide primary care, and quotes the head of the American Academy ofÂ Family PhysiciansÂ — whichÂ appears to haveÂ many of the characteristics of a trade group as well as a scientific and professional society.
Primary care doctors are great.Â It’s terrible that the incentives for young doctors to enter into specialities are so skewed.Â 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.Â 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.Â Or both.
Author: Jonathan Zasloff
Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees.
Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses.
Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.
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