Disruptive Nonsense

The geniuses at the American Enterprise Institute have used all their collective brilliance to fix the healthcare system as displayed in this article:

  • A Drudge headline right now highlights this medical math: 30 million Americans currently without health insurance will be getting coverage next year. But by 2020, there’s a projected shortage of 45,000 primary care physicians.
  • This seems like a big problem. But there is an obvious solution: Give more autonomy to nurse practioners. As this AARP blog post points out, “the American Association of Nurse Practitioners [have] 43,000 members who say they can offer basic care if state laws would just let them set up an independent practice without doctor supervision.”
  • Clayton Christensen argues that nurse practitioners working in retail clinics — such as those at Walmart, CVS and Target – can offer care as good as or better than what doctor’s offices provide — at about 40% lower cost.
  • Family doctors, not surprisingly, hate this idea. Then again, established players never much like disruptive innovation.
Do you see how bullshit claims like this, which claims NPs offer” as good or better care”, are perpetuated?     That is such garbage.   There are no good studies to prove that and I recently have blogged about a study, which are finally being done, showing the opposite.  And I love that they think that we family docs hate disruptive innovation.  Kiss my ass, dude.   Retail clinics treat simple things.   Complex issues needs time and a relationship with your doctor….your family doctor.    Fragmenting care is not innovation.  If you want to solve the physician shortage, and they really mean primary care doctor shortage, then tweak the payment system so medical students choose that specialty.  It is that TWEAK that will be disruptive innovation!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “Disruptive Nonsense

  1. Kurt
    April 12, 2013 at 2:54 pm

    I agree this is another reason to stay away from Family Practice.
    I work with a good NP who does a fine job. I don’t think they are all this good. Was a plain jane nurse for a few years, then oncology nurse for 9 years then back to school for masters and NP. Smart and does well.
    Let’s face it the NP’s, good or bad, are going to convince the politicos to grant them full rights. It’s coming like it or not.
    Just another reason to stay away from F.P. What kind of BS pablum are they feeding the med students these days. The uncompensateable paperwork is horrendous as opposed to 25 years ago and lets face it,
    people aren’t going to change their shitty habits unless it’s going to cost them. I’ve talked to people until I’m blue in the face and the vast majority don’t change their habits. They don’t want medical advice, they want magic so they can keep doing what they’re doing.

  2. Pennsylvania Patient
    April 12, 2013 at 2:02 pm

    Incidentally, if you study the history of American medicine, it’s always been about this issue: the physicians trying to deny entry to others they deem inferior, to maintain power, prestige, and high pay. First it was the bonesetters and osteopaths, then the midwives, now the NPs. Read Paul Starr’s The Social History of American Medicine for the full story. I’m betting an NP can deliver a baby just as competently (with the backup of a hospital setting) as an MD.

    • Doug Farrago
      April 12, 2013 at 3:00 pm

      Once again, your argument is brilliant. By all means, transfer all of your care to less qualified healthcare givers. Then you can continue your logic with a Nurse Practitioner Assistant and so on.

    • mamadoc
      April 12, 2013 at 9:14 pm

      Right. And do your C-section, too?

  3. Pennsylvania Patient
    April 12, 2013 at 1:58 pm

    I say let the NPs have at it, and grant them entry to the system. I have three ‘regular’ doctors, a urologist, a gynecologist, and a primary care doc, who work in the same medical system and are covered by that system’s insurance. Despite being in the same system with equal access to my electronic med record, NONE of them talks to each other unless I prompt them to when it comes to problems that are related to all 3 areas. It’s like the blind man standing at the trunk of the elephant, the mute man patting its side, and the deaf man feeling the elephant’s tail. Maybe the NPs would actually have time to speak with one another and come up with an effective solution to my condition (which so far eludes; gee, why?)

    • Doug Farrago
      April 12, 2013 at 2:59 pm

      So….because in your case your healthcare team doesn’t spend enough time around the table talking about you we should just let NPs take over. Yeah, that’s brilliant logic.

  4. Dr Jim Beard
    April 11, 2013 at 12:58 pm

    Touchdown. I learned early on not to believe everything you think. Even passionately held beliefs are no subutitute for data. I was a primary care pediatrician for 20 yrs, and now do Developmental-Behavioral Pediatrics (I am double boarded) and I certainly know more than I did as a pediatrician, and I should certainly know more than the NPs I supervise. Why else would they bring me questions and seek guidance. JB

  5. mamadoc
    April 10, 2013 at 8:53 pm

    The dirty little secret about midlevels is that they INCREASE costs because they rely much more on advanced imaging and specialist referrals. The public is too dumb to figure out that these people get 5000-7000 hours of training before they’re released on the unsuspecting public, an FP has 22,000 hours. “Disruptive innovation” my Aunt Fanny.

  6. Bill Newton MD
    April 10, 2013 at 7:34 pm

    Tweak the system so ALL physicians get paid better. Then maybe the better students will start going to med school instead of business school.

  7. Ellen, RPh
    April 10, 2013 at 2:35 pm

    I have never found a NP that could take care of patients as well as I think I could!!! I’m an unusual pharmacist who has done a lot of diagnostics study. But good grief, NPs are nowhere near as capable ad MDs. They seem to be overly sure of themselves and mostly wrong.

  8. April 10, 2013 at 9:29 am

    As you noted the cost at Walgreens and CVS. Is in not suspicious that the drug stores will have the NPs and where will the prescriptions be filled? They could take them to Costco, but would it not be easier (and get $5 coupon off lipstick) to fill it here while you are in the pharmacy?

  9. Pat
    April 8, 2013 at 1:33 pm

    1. Treat an increased portion of patients at the routine, simplified care” level. Chronic, “simple” problems may be addressed, but…
    2. Chronic complex problems, or the complex sequalae of “simple” will need specialty referral, with less intensive management at the “simple” level, so…
    3. More specialty referrals, and therefore more $$ spent on a disease now progressed…
    4. More calls to reduce specialist pay and services results in less specialist access, leading to the need for more complex care coordination with the primary care physician…
    5. Oops!

    A huge economic question is whether the savings in managing chronic problems, um, “simply” will outweigh the new costs incurred from more previously simple cases now requiring more specialist oversight and cleanup. I’ll bet my bottom tax dollar that there are studies that prove exactly this point – studies funded either by insurance companies for max short-term profit, or by quasi-government entities with a single-payer agenda. In either case, there will be a cyncial intent to placate greater masses of patients with the appearance of “free” care (vaccines, blood pressure checks, pats on the head), while the lines for neurosurgical evals and early prostatecomies grow longer.

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