As of 2012 there were an estimated 624.434 practicing physicians in the United States, 437,639 of them specialists. Today's physicians have become more and more specialized, with sub, sub specialties, leaving fewer and fewer general practitioners to give primary care.
Under those conditions, how can we add 11 million new patients and still give better care? We can do it by giving new roles to health professionals in new organizations with new reimbursement plans. And, not to worry, that's exactly what's happening right now! Other able health professionals are stepping in to take up the slack and in many ways doing a much better job.
We have approximately 3.5 million Registered Nurses. Over 85% of them are employed in the health system, giving a ratio of approximately 8.5 nurses per patient. We also have about two to three million licensed vocational nurses and/or nurses' aides, orderlies and other support staff. The statistics on this are foggy, since many of these people move in and out of healthcare and are called different things in different states.
In 2010, approximately 56,000 nurse practitioners and 30,000 physicians assistants were practicing primary care in the United States, according to research commissioned by the Agency for Healthcare Research and Quality. These numbers are expected to skyrocket as more primary care professionals are needed and generous government grants are offered for their education.
Before you cry out, "Oh no! I want a doctor, not an assistant!" let me assure you that the care patients are receiving from these professionals is equal to or, as many say, better than what physicians are able to deliver today. That's because the Nurse Practitioner (NP) or Physicians Assistant (PA) can spend more time with you to answer your questions and educate you about your condition.
The fact is, primary care is not rocket science. There are two basic components to health care. The first is the DIAGNOSIS: finding out what's wrong with you. The second is TREATMENT--treating or fixing what's wrong with you. About 99% of all diagnoses are simple: common diseases, sore throats, ear aches, fever, pains here or there, high blood pressure, asthma, heart problems, broken bones. You don't need a doctor to order an x-ray to see if a bone is broken. Then, there are the diagnostic trees, the programs health professionals use after they have taken the history and done the physical exam. If the diagnosis is not obvious, they can enter the symptoms and the program will ask questions and request further exams or tests to verify the diagnosis. At that point, if the NP or PA has any doubts about the diagnosis, either one does the same thing physicians do. They refer up the line to their affiliated physician, who, if he (or she) is stumped, then refers the case to a specialist. The specialist in turn often confers with other specialists in an effort to get the right diagnosis. (Needless to say, even the specialist, being human, can miss a diagnosis or get it wrong!) Obviously, patients with complicated, rare and dangerous conditions are not going to be diagnosed by a Nurse Practitioner or Physicians Assistant.
Health care professionals also play a key role with treatments, most of which are generalized and have been around for years. In fact, this is an area where NPs and PAs can outshine physicians. They are better at explaining the patients' condition to them and getting them to cooperate and follow the treatments as directed. As for patients who would still prefer to be seen by a doctor, here's a big surprise. Nurse Practitioners and Physicians Assistants have advanced degrees, at least a Masters. And, beginning in 2015, all newly minted nurse practitioners will have to have their doctorate! But that's another article.
Financially speaking, you could visit an NP or PA five times, and it would not cost you or your insurance as much as you spend to see a physician. Then, there's the matter of Emergency Departments. Hospital care is the most expensive type of health care, and Emergency Departments provide the most expensive care of all. Most lay people have no idea of how massive an array of equipment is needed to stock an ED, or of how high a level of skills the personnel must have to enable it to work 24/7.
Since the laws require that anyone coming to an emergency department must be treated, maintaining the ED is the number one cause of public hospitals going bankrupt. Not only is treatment there the most expensive, but the ED is the most chaotic department in the hospital. More mistakes are made there, and more lawsuits started, than anywhere else. It's little wonder that many hospitals are closing their emergency departments. From 1997 to 2007, visits increased by 23%, and by 2007 there were over 117 million visits, according to a new National Health Statistics report. There is virtually unanimous agreement now that the costs of ED visits are off the charts. So the number one plan for saving money in health care is to get as many patients as possible out of the Emergency Departments! That plan can be further validated as a good one, because statistics tell us that 80 to 90% of patients coming to the Emergency Department don't belong there anyway!
Need I remind readers that the Emergency Department was devised to take care of people with life-threatening conditions? Instead, it has become the primary caregiver of the poor, the uneducated, immigrants, and others who, not having health insurance, know they can get free health care there. Every poor misbegotten with a sore throat, sprained ankle, infected tooth, or belly ache ends up there knowing they cannot be turned away.
Retailers Are Providing Alternative Care
Cultural Changes are being put in place to deal with this problem. The first is the CVS MinuteClinic. Their web site reads: "MinuteClinic brings the care you need to your neighborhood," and states further:
"You may already know how convenient we are:
- Open 7 days a week, including evenings and weekends
- No appointment necessary
- Located in select CVS/pharmacy stores nationwide
- Adding new clinics and services all the time
- Plus, we accept most insurance plans
"Do you know that we offer a broad range of services to keep you and your family healthy? In addition to diagnosing and treating illnesses, injuries and skin conditions, we also provide all kinds of wellness services, including vaccinations, immunizations, physicals, screenings and monitoring for chronic conditions.