I was watching an expose on CBC’s Whistleblower segment, S2E4 titled “Doctors versus Midwives”. This episode showed a very small example of an ever growing, concerning trend of less trained midlevel providers providing care to higher risk patients that should be seeing physicians. This segment hit on the trend of large health care organizations eliminating physician positions for lower cost providers and even more concerning promoting these providers as equivalents to much greater trained physicians.
This opinion piece is in no way diminishing the value of nurse practitioners, nurse midwives and physician assistants. Their contributions to the care of our patients is crucial if that care is for an appropriate acuity patient with physician oversight. My concern is that these individuals are being manipulated by large corporate medicine to provide care they are not adequately trained to provide. Worse yet, it is their own teaching institutions and professional organizations that are jumping on this band-wagon to line their pockets by perpetuating the myth midlevel providers they can provide the same care as a physician. As states continue to push through legislation for midlevel independent practice I suspect things will continue with a downward spiral and physician involvement and oversight will not be required at all.
I enjoyed watching this recent Whistleblower episode. It provided the public with a glimpse of the state of healthcare. I suspect it will be viewed as an isolated occurrence rather than a rampant problem, but nonetheless it will bring some awareness. What disturbed me the most in the episode was that at no point was the training differences of nurse midwives and OB/Gyn physicians ever addressed which was very unfortunate. The only difference mentioned was the pay difference. The other concerning issue, and I doubt many were even aware, is that the only reason this problem ever made it to the level it did was because of the component of fraud. When fraudulent billing was determined there was an avenue for the attorney to get involved. It had nothing to do with the mismanagement of care resulting in harm or this heroic physician’s concerns going on deaf ears to the point she was actually terminated.
I do encourage everyone to watch this episode. I fear we will see more of these tragedies as corporate medicine pushes lower costs at the sake of high quality physician-led care.