Saw It Coming


A trio of bills that state Sen. Ed Hernandez introduced in California would allow nurse practitioners, pharmacists and licensed optometrists to expand their practices in some capacities to help “close the primary care gap in the state”.   Basically, it let’s them set up their own shop.   If you have ever read this blog you would know I seen this trojan horse coming for years.   I have always said that this fight started when NPs claimed to want collaboration but changed their minds and now want competition.  Here is what Mark Dressner, MD, president of the California Academy of Family Physicians, said:

While many legislators voted for the bill with assurances that amendments would be taken to require some level of physician involvement, the current language is too general and does not ensure physician collaboration.

Little secret, Mark, that is exactly what they don’t want.  They feel shackled by us.  In fact, when the bill was changed to have some oversight, the AANP withdrew their support.

Doctors will lose this battle.  I know that but it doesn’t mean we shouldn’t fight every step of the way.  The NPs always had a game plan and the AAFP was always trying to appease.  The problem is that they were being played.   The ACA was the perfectly vehicle to do us in.  As Sen. Hernandez said, “What good is a health insurance card if you can’t get into see a health care provider when you need one?”  Exactly.  And instead of finding the right incentives to become a primary care doctor they have put all their eggs in the trojan horse.  Sorry for the mixed metaphor but it just fits.

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] 

  4 comments for “Saw It Coming

  1. Bruce Bonanno, MD
    September 2, 2013 at 4:17 pm

    Nice that a recent study came out that showed that these MID LEVEL providers (NP and PA’s) are only going into primary care 50% of the time.
    SO why not pass these bills but make it only for PRIMARY CARE IN UNDERSERVED AREAS?
    wonder how fast they will support these bills then!

  2. Ben
    August 28, 2013 at 11:04 pm

    So lets see,
    NP demand same rights and pay as FPs
    FPs demand same rights and pay as specialists
    I see a pattern here.
    Therefore specialists with 7 years of training (some very hard especially before the new rules), and 4 years of medical school will make the same as someone with 2 years of 9 to 5 training after college, and no medical school debt.

    Also the supposed primary care shortage. Just like the gas crisis in the 1970s. There is no shortage just artificial price controls. When the government tried to control the price of gas the result was – a shortage of gas. When the government controls the fees paid primary care doctors, a “shortage results”. If there were no government controls, artificial economics, then there would be no shortage. Other doctors would do more care.

    The government wants to claim there is a shortage so they can create a glut of doctors and make them a commodity. Wont take Medicare or Medicaid despite the rates, well someone else will if there is a glut. The bad news is they will waste talented smart young peoples lives, training them and sacrifice and they wont find a job unless they do what the government says.
    The medical schools and academics join the “shortage” club as more trainees means more money for them, and more slaves to keep the academic money machine going.

  3. Kurt
    August 28, 2013 at 2:49 pm

    All the more reason to stay out of primary care as a physician. I hear from an alumni rag that they are creating more primary care docs. Wonder what BS they’re feeding them to convince the med students to
    screw up their life.

  4. Pat
    August 26, 2013 at 11:54 am

    And clearly the professional societies have made for damn poor condoms.

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