What to say when the free market conflicts with common sense? It happens every day, and we should not think that medicine – such as it is – could rise above it. I’ve written repeatedly here that I think patients should be free to see anyone they want for almost anything, and I should be free to not have to deal with any of the consequences.
We here celebrate Direct Primary Care, as it represents the very best, most effective, and one truly honest way to deliver health care to the individual patient. But can DPC be delivered by non-physicians? I guess, yeah, sort of, in the same way that any other health care can be delivered by the Less-Educated, Less-Trained. On occasion I pop into the Family Dollar General…but I never mistake it for Target.
Stacy Waack and Tara Taylor are both physician assistants at Benessere Wellness Center in Michigan who offer services along the scaffolding of DPC: “monthly membership fees instead of insurance company reimbursements and co-pays. Adults pay $69 per month and a family of four spends $149 per month for unlimited visits, exams, urgent care and some tests. Families pay $10 per month for each additional child.” “They can teleconference, send photos via email or use FaceTime or Skype. ‘If you call the office and need to speak with one of us, you’ll speak with us directly. After hours, you’ll speak with us directly as well.’” They limit their panel to 500-600.
Aaaand then we take a dirt road right off the reservation…
“John Young, president of the Michigan Academy of Physician Assistants assures us, “PAs are trained in the medical model like physicians. PAs have partnered with physicians across the state to own medical practices. (Benessere) is the first time we’ve heard of a PA-run or PA-owned direct primary care practice.”
Well, you’re trained in a medical model, but not “the” medical model, otherwise I’d be referring to you as “doctor.”
PA Young: “Pairing direct primary care — which focuses on high-value services such as disease management, prevention and mental health — with a ‘high-value provider,’ such as a physician assistant, makes a lot of sense.” Which is to say either that actual physicians are “low-value”, or more accurately, that LELT’s are the bargain option.
And PA Young just had to add, “We are proud of our proven track record of providing high-quality care with our physician colleagues.” Mr. Young, as “a cardiovascular surgery physician assistant” you could run annuloplasty rings around me on that particular topic. But you were not there for the never-ending death march of board exams, the long uncompensated hours over a decade of training, the disgusting late night dumps in the ER, the sleep-deprived zombie rounds that followed in the ICU, the never, ever, always more blur of clinic and lecture schedules. I haven’t seen you in any of the malpractice depositions or subpoenaed “medical expert” court appearances. Mr. Young, you might be a swell guy, and a pleasure to have a beer with. But Mr. Young, you are not now, nor will you ever be my colleague until such day as they tattoo that bulls-eye on your back while you are green hooded, and you earn the title “Doctor of Medicine.” I earned that, along with all the scar tissue and paint knocked off the keel.
I really don’t mind these little PA’s making a buck here or there, any more than I mind anyone else doing whatever they please. As long as it involves consenting adults, I don’t care if the half-ass tattoo “artist” cons idiots into accepting auto grade silicone injection butt enhancements. As long as the government stays out, let the educated consumer beware. But through medical licensing and CME requirements, DEA licensing and surveillance, among others, government still has its thumb on the scale against physicians; if PA’s are allowed to do all that a family doc can, then the worth of the latter is artificially reduced by government restriction.
And these “DPC” PA’s are seeking to play unsupervised family doctor against a backdrop of government, hospital, and Big Insurance opposition, which will become open hostility. As real DPC takes off, expect the “cost-effectiveness” the PA’s tout to be used to further attempt to restrict real physicians from practicing DPC.