Doctor Shortage: Short Doctors

This article (1) is not about short doctors under 5’10”, it’s about a shortage of primary care physicians (PCP). Sources indicate:

“The United States will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply, according to new data published today by the AAMC (Association of American Medical Colleges). The projected shortfall is similar to past projections and ranges from 46,900 to 121,900 physicians.”(2)

The article then goes on about talking points about how Advance Practice Registered Nurses (APRNs) can replace PCPs to fill this shortage. The article professes APRNs as medical professionals, who have at least a master’s degree and have worked as registered nurses, and are formally trained to provide much of the same care that a standard doctor does. The inference is that APRN’s practice medicine like doctors practice medicine. As a former APRN now MD, I counter this notion in that one discipline cannot fill the gap of a different discipline. However, talking points such as those in the article where it states: “Studies have shown that receiving medical care from an APRN results in equal (or sometimes better) outcomes for patients.”This statement is not cited with references and has been refuted in prior blogs I have written about (3,4). In fact, studies show the opposite (3-5). 

The article also reports:

“…. asks naysayers which health professional is more likely to move to a rural county and fulfill the major healthcare needs of a small community: a doctor who can find plenty of high-paying work in urban areas, or an APRN whose nursing background involves more hands-on time with patients and less student loan debt?”

            This notion of increasing APRN practice in rural areas has also been refuted in a prior blog I wrote about. The argument is that full practice authority is needed in order to increase access to primary care in rural areas. This turns out to be a straw man argument (6). Nothing more than a talking point. I am pro-APRN on physician lead teams and am pro-truth. Truth is, studies referenced in articles such as this are rarely cited and if cited, the studies can be refuted on poor methodology and/or skewed/biased data (7). So when it comes to the impending doctor shortage, it’s my belief that the gap should be filled with short doctors, tall doctors, fat doctors, skinny doctors, male doctors, female doctors, DO doctors, and MD doctors. Replacing one discipline with those in the same discipline. It is inappropriate to fill the gap with another discipline. 

REFERENCES: 

  1. https://www.nevadacurrent.com/2019/07/26/nurse-practitioners-are-one-part-of-solution-to-nvs-doctor-shortage/
  2. https://news.aamc.org/press-releases/article/2019-workforce-projections-update/
  3. https://authenticmedicine.com/forget-the-beef-knock-off-meat-substitute-is-worse-than-no-beef-an-expose-on-aanp-position-statement-quality-of-nurse-practitioner-practice/
  4. https://authenticmedicine.com/wheres-the-beef-part-1-a-critique-one-study-at-a-time-on-nurse-practitioner-full-practice-authority-model-vs-physician-supervision-collaboration-model/
  5. Lohr, Robert H. et al. (2013) Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners.” Mayo Clinic Proceedings , Volume 88 , Issue 11 , 1266 – 1271
  6. https://authenticmedicine.com/straw-man-the-dishonesty-needs-to-stop/
  7. https://authenticmedicine.com/a-take-on-evidence-based-medicine-a-biased-report/

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  5 comments for “Doctor Shortage: Short Doctors

  1. Ty Webb, MD
    August 13, 2019 at 8:13 pm

    Observations from 21 years of rural primary care : As long as we have a physician shortage, we will have other proposed solutions for comprehensive medical care. We must remember that comprehensive care (primary care) and urgent care (limited care) are two different things.
    Also, Physicians have long delegated responsibility in limited areas, just as any business owner or executive would. You could very easily make the argument that any executive secretary/assistant in this country could do 70 to 90% of what their boss does. That doesn’t mean that you would have executive secretaries and assistants operating independently, but rather as part of an effective team.
    A well trained NP/PA SHOULD be able to ‘do’ 70 to 90% of what their supervising physician does. The challenge is that this doesn’t mean 70% of patients get 100% care, it means ALL patients get 70 to 90% effectiveness of care. That is why being part of a team is so important. While not every physician is able to be a team leader, physicians are those who are trained to function in this role.

  2. Jennifer Hollywood
    August 13, 2019 at 9:17 am

    In my experience, NP’s and PA’s are NOT filling the gaps in primary care. They are supporting surgeons and other non-primary care physicians. In my community, there was one group of NP’s that did primary care. Only one of the primary care practices in my community employs PA’s. (The local OB/Gyn office employs both NP’s and Midwives.) Most of the NP’s and PA’s are employed by specialists including: neurology, nephrology, orthopedic surgery, dermatology, cardiology, gastroenterology, neurosurgery, and endocrine. The procedural specialties use the PA’s and NP’s to screen the patients for procedures and do the follow ups. It is hard to get your patient to see a physician for the first visit in many of the practices.

    When I first started practicing in the 1990’s, specialist referrals were handled very differently. Patients were seen, recommendations made, and the patient was sent back to me for care. NOW the specialist seems to want to keep them forever, even though they are often not adding anything of value. It is the new business model. Keep the patient as long as possible. It keeps money in your pocket and keeps your PA/NP’s busy. If they were to simply return the patient to my care after the referral then there would be less need for specialist professionals of any level, and it would be quicker and easier to get the patient seen by a specialist when needed.

  3. Jesse Lee Belville,PA-C
    August 12, 2019 at 9:58 pm

    As a PA-C for 43 years in Primary Care/Family Practice, I do 70 to 90 % of what my supervising Physician does. I have worked mostly Rural Health.Covering family practice and Lots of Rural ER’s. In all those yeats I have had 2 Physicians who actually supervised and helped me improve my skills. Often I was utilized as a low cost MD or DO. Also disposible after 3 or 4 years. Fun stuff. You our Fearful leaders, busy pursuing whatever, lost control of this glorious profession. MD/DO’s created PA’s, to enhance your services, improve patient care while under your guidance. NOW this BUSINESS model is out of control.. How are you guys going to modify it? Or can you. Do you have the POLITICAL and FINANCIAL will to take over? Or just continue to go along to get along. This is what is. Do you / we/us have the foresite, will and wisdom to Change it. Or just Whine.. This old guy, always #2 behind my Supervising Physician, will continue to watch and learn.

    • Tim Blain, MD
      August 12, 2019 at 10:42 pm

      I honestly think that if physicians “actually” had the time to supervise (akin to residency training) mid level providers in a meaningful way that many could in fact very capably fill the gaps.

    • Steve O'
      August 13, 2019 at 12:02 pm

      Right on Jesse!

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