Selling Us Down The River
Here is a nice article in Business Week that makes doctors out to be the bad guys in the nurse practitioner battle. It is the same old, same old. And without doctors being unified or pushing back, we will lose this battle. I won’t rehash the same old arguments. You can read them in my other blog entries. My issue is with the person the author uses as their expert go-to-guy on this subject. The article quotes from John Rowe, a physician and former chief executive officer of Aetna, who is now a professor of health policy and management at Columbia University. Here is what he said:
“Doctors will tell you, ‘We trained longer, and by the way we were smarter to start with because it is harder to get into med school,’ ” says Columbia University’s Rowe. “You could take an example of someone like me: I trained in internal medicine at Harvard. Trained at NIH. Came back through Mass General. Fellowship in kidney disease. I was chief of geriatrics and a professor of medicine. Do I know more than a nurse? Of course I do, but I don’t know more about providing core primary care.”
That’s right. You don’t know more about providing primary care. We primary care doctors do! This moron has so little respect for family docs and internists that he doesn’t even know we exist.
And that is why primary care is screwed.
Just another SOB who couldn’t make it in practice and sold his soul to the dark side. I know a heckuva lot more about core primary care than he does or a midlevel does. He never practice primary care in his life.
Simple. Give the FNP’s full office privileges. Currently all the supervising doc’s have to sign off of narcs, stimulants and much of the the “patient paperwork”. Once they end up having to do all this “uncompensatable” paperwork, they will all move to the specialty NP groups.
I tell you, the FNP’s will be taking over. Once the primary docs give up hospital practice to the hospitalists, we’re ending up doing nothing more than office work that can mainly be done by NP’s. Don’t give me that BS that we docs “do a better job”. The NP’s do pretty good. A visiting cardiologist from the “big city” tells me the hospitalists don’t give a shit about the patients, take a “don’t die on my shift” mentality and don’t know what’s really going on. Likes the fact we can fill them in on the background on our patients we ask them to see locally. When I care for my folks locally, I try to make sure they’re good enough to leave so they don’t end right back up in my office sicker than snot. The big city hospitalist doesn’t care if the patients end up sick on my doorstep after they discharge them. Hell, they’re probably off shift anyways and won’t be
seeing them again. The AAFP is going to be in dire straights in 15 years.
Dr. Hockey was right to bail when he could into something else.
The major issue with Pricare today is patients are not held accountable for
their horrible habits and society’s “let’s blame the doctors attitude”.
A fair number of patients want “magic” from a bunch of nursemaids so they
can keep shoving the Krispy Kremes down their gullets and stay thin.
Oh and they want this “magic” for little or no cost.
Idiot.
Like John Rowe, I went to a highly ranked medical school, residency, and fellowship. My lowest score on a national exam was the 93rd percentile. I did family practice for a couple of years before my surgical training. And, I agree with John Rowe when he says, “I don’t know more about providing core primary care.”
However, had he practiced as a primary care physician, he WOULD “know more about providing core primary care.” Right now, he is just another IDIOT about primary care and would do well to keep his uninformed comments to himself.
Sorry. I don’t like to rant, but I could not control myself about this one. I’m feeling a lot better now.
Okay, Doug, true points all. But what does this parasite do now? He’s a “professor of health policy and management at Columbia University” i.e a pontificator for and celebrant of collective apporaches to the further commodification of health care, supported by a leftist institution of “higher” learning. Trained at Harvard? Trained at NIH? This son of a bitch has been well inculcated in the mores and rhythms of health care as right, dispensed by beneficent central authority. This is one of the onerous establishment docs, an AMA card-carrying pantheon unto himself, that was happy to dispense sage platitudes while taking the easy money for decades, feathering a nice golden nest of cash and public adulation, while leaving the droppings below for the follow-ons to clean up. Hey Dr. Rowe, YOU and your generation created this mess. The hard questions were not about glomerulonephritis or renal acid-base balance, but what was the proper role of the physician re: the patient irrespecitve of these bureacratic monuments you constructed to yourselves. The question wasn’t just how we can put so many people on dialysis, but WHO would pay for it and how that would impact everyone else unafflicted by anything other than the self-importance of “leaders” such as you. If only you and your sorry kind could have considered the warning by Dr Malcolm in “Jurassic Park”: “Your scientists were so preoccupied with whether they could, they didn’t stop to think if they should.”