In the late 1950s my father was a patient in one of the major Boston hospitals suffering from cancer of the pancreas. His physicians had little to offer, but his nurses were wonderful. They were kind, considerate, gentle and warmly human. Who were these people, where did they come from, how did they become professionals? Almost all came from poor backgrounds, were graduates of two-year hospital-based nursing schools where their costs were minimal to none. Upon graduation they immediately joined the middle class as registered nurses, (RN) productive members of society. To my mother and me they were the bright spots in an otherwise miserable situation; my father died, emaciated, a few months later.
During the late 1960s and 70s there arose within the nursing community the perceived need for more prestige and higher pay. This culminated in four-year baccalaureate degrees in nursing granted by universities and colleges, with its attendant high costs and fees (Ref.1). The 2-year low-cost hospital programs became mostly extinct by the end of the 20th century. But now the baccalaureate RNs were too well educated to mostly deliver direct nursing care to patients; they became head nurses and executives. Direct nursing was delegated to nurses aides, licensed practical nurses and others (Ref.2). This then became the low-cost entry for poorer young people into healthcare, but with significantly lower prestige and income. Then with time ambitions grew. Could nurses become equal to doctors, just a little different? Why not become a Doctor of Nursing Practice, DNP, and demand more authority, prestige and income (Ref.3)?
But what economic conditions would facilitate DNP nurses to become an alternative to a primary care doctor? In the U.S. we have a government dominated third party system that disregards indivuality and self-responsibility and is strife with politically savvy middlemen who are growing fabulously wealthy at everyone else’s expense. Costs are bankrupting the country yet with millions receiving poor or no access to care. Our politicians responsible for this failed system, instead of addressing the root causes and giving up all that lobbying money, say they are concerned about access for those unable to obtain care. This presents an opportunity for corporate middlemen like CVS, etc. to claim to fill this need with advance practice nurses (DNP) while paying far less than for a physician. They encourage dispensing their own Pharmacy Benefit Managers (PBMs) drugs and control an insurance company to direct their covered patients’ care to the DNP in the store: just imagine the profits (Ref.4).
How can we in the U.S. escape from this highly politized healthcare morass? We must offer to those Americans who wish to direct their own care the ability to do so by having the option of robust health accounts that pay cash for most care along with the purchase of nationally available true catastrophic insurance. This can be funded via employer and means-tested federal/state and Medicare deposits. Patients then would have the means to choose when, where and how to receive the medical care that best meets their individual needs at that point in time, which could vary from multiple sources and individuals. A similar program has been proven to be effective for even the poorest of individuals (Ref.5). Market forces would then determine the optimal activities for nurses.
1. Jean C. Whelan, Karen Buhler-Wilkerson, American Nursing: An Introduction to the Past, University of Pennsylvania, 2011, available at: https://www.nursing.upenn.edu/nhhc/american-nursing-an-introduction-to-the-past/#:~:text=By%201960%2C%20approximately%20172%20college-based%20nursing%20education%20programs,advanced%20roles%20in%20the%20delivery%20of%20health%20care. (Accessed May11, 2021)
2. Indeed Editorial Team, What Is a Practical Nurse? LPN vs. CN vs. RN, Average Salary and How To Become a Practical Nurse, Indeed Career Guide, February 23, 2021, available at: https://www.indeed.com/career-advice/finding-a-job/what-is-a-practical-nurse (Accessed May 11, 2021)
3. Melissa De Cápua, Are Nurse Practitioner Doctors Real Physicians?, Barton Associates, April 21, 2021, available at:https://www.bartonassociates.com/blog/are-nurse-practitioner-doctors-real-doctors?fbclid=IwAR1nm2iIQPwwSx_O7KJ_YpjFOx5D5TOg4jjoT4l1O-sgEU2g5r7k5AMtOSM (Accessed May 12, 2021)
4. Drs. Ken Fisher and Marion Mass, Put The Brakes On The CVS Aetna Merger To Sustain Competition AND Choice, The Hill, December 17, 2018, available at: https://thehill.com/opinion/healthcare/421697-put-the-brakes-on-the-cvs-and-aetna-merger-to-sustain-competition-and (Accessed Dec. 17, 2018)
5. Avik Roy, Obama Administration Denies Waver for Indiana’s Popular Medicaid Program, Forbes, Nov. 11, 2011, available at: http://bit.ly/2t4vNUH
(Accessed May 13, 2021)