A New Primary Care Practice With Only Nurse Practitioners
A new practice opened in our town and it was on the front page of the newspaper. The providers are all Nurse Practitioners. There are no Physicians.
Now, on hearing this, most readers of this blog, us included, immediately grabbed our anti-angina medication.
But, there is more: Towards the end of the article was an interesting comment: 90% of their patients are on Medicaid. The practice is able to survive on this payer mix. I’m presuming they are not exaggerating.
Let us pause to ponder the situation with Medicaid. In the old days, to modify the old joke about Communism, doctors treated Medicaid patients and pretended to charge Medicaid and Medicaid pretended to pay the doctors. On the plus side, you could pretty much order the tests you needed and you could comfort yourself with the illusion that you were “giving back” to the community.
Then, states turned Medicaid over to the insurance companies and the nightmare began. Not only were you barely getting paid, but you also could not order even the most basic of tests without an enormous gauntlet of obstacles. Every element of care is blocked. That is where we are today and most doctors have fled Medicaid. The only people getting paid are the insurance companies.
The problem is, if you have Medicaid, you probably can only see one clinic: The Emergency Room. There are a lot of patients now on Medicaid, so the problem is not trivial.
So, here we have a potential solution to the problem: A clinic willing to see Medicaid patients but staffed only by NP’s. Is it great? Is it better than nothing because the alternative today is literally no care?
So, we are riding the slippery slope down and the next stop will extend to all Medicare patients. Then, the rest of us will get trapped. Maybe we just jump to the end game and eliminate Primary Care as a field for doctors? Then we go further and eliminate doctors from other fields like Neurology, Endocrinology, non-invasive Cardiology, etc.
There’s a couple of these in my area now. Patients believe they are doctors. And I doubt they do much to clear up the misconception.
Yes ,I remember the barefoot doctors of China. Also Dr Stead stsrting the first PA PROGRAM at Duke Univ. in NORTH CAROLINA.. Weird place Duke. I learned about PA’s in January 1970 While in AnKah Vietnam.I was a Medic..Spent 19 months in VietNam. Nice people, beautiful country, Came home, worked nights, got married, went to PA school graduated 1976.Working with a PHYSICIAN, as #2 doing routine care while he handled the more difficult cases……
I wish, nope I was often utilized as a cheap Doctor. Long hours, many physicians got defensive,
said unkind things about me and other PA’s.
Physicians if you want it to CHANGE, GET OFF YOUR ASSES ORGANIZE AND MAKE THE CHANGES AT CITY,COUNTY, STATE AND FEDERAL LEVELS..NO ONE ELSE CAN.
But you will not to much politics in medicine as you all challenge eavh other to see who has the most power/influence in your little worlds.. So SAD. You cannot help yourselves, sucks to be simple Human Beings..
Jesse Belville,PA-C
Jesse, don’t get me wrong. I trained with the first PA’s to graduate from my med school. I taught and hired PA’s and nurse practitioners in my practice for decades. I’m just opposed to NPs and PA’s passing themselves off as doctors with the same training. We need all the good help we can get.
We had an independent nurse-practitioner clinic in our area. The Payette Clinic, Vancouver WA. After some adverse publicity, they re-opened as “Walnut Grove Medical”. And say what you will about trial lawyers, I’d say they did the world a favor by suing them into oblivion.
A little over a decade ago, an oldie but goodie. Here’s an article on them, from the Seattle Times.
https://www.pulitzer.org/files/2012/investigative_reporting/seattle/methadone-exhibit3.pdf
They got a Pulitzer for the coverage.
Look at the prescription bottle for Methadone. Look carefully. Expand the picture, as I suspect you will doubt what you are reading. YES, you read it correctly. They called themselves pain specialists.
I can tell you, this was not an aberration, it was not all that unusual for them. Pharmacies in the area, at regional corporate level, ordered their pharmacies not to fill prescriptions from that clinic, because of practices like this. Pharmacy chains do not do that because of a single outlier; this was ar for the course for them.
Anybody remember the so-called “barefoot doctors” across Red China in the late 1960s? That’s where the U.S.A. seems to be heading. Well, since most illnesses among Americans are self-induced, I guess we’ve earned the crappy care.