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<p>Perhaps you are too healthy to need to go to the doctor often enough for them to bother?</p>
<p>“Our local clinic is replacing Drs who leave the practice with Physician’s Assistants and Nurse Practitioners. I absolutely love my PA! She spends much more time with me than my MD ever did and is much more thorough. I think this is the way we need to go with health care. I think this is the way we need to go with health care.”</p>
<p>Wow, so you think we should get rid of insurance AND doctors? Right now, at least in many states, NP’s and PA’s are theoretically supervised by someone. Are you thinking we should do away with that, or that their should just be one or two MD’s doing the supervising, and all the care being provided by PA’s and NP’s? That’s certainly what seems to be happening to children with mental health/behavioral problems around here. And kids with medicaid.</p>
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<p>Clinic I work for does not take Medicaid. It’s just not worth the hassle. </p>
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<p>I think this is the future. Good or bad? I think it’s too early to say for sure. If it’s done right, it can work well…</p>
<p>I have had a concierge doctor for the past 2 years. I went that way when I found myself waiting far too long to get appointments with my previous doctor and then waited far too long in his waiting room to see him (on average - 2 hours). I was facing open heart surgery and worried about follow-up care.</p>
<p>I have to say I LOVE my new doctor. I can see her whenever I need her (after my surgery there were several times I called at 8am when the office opened and was in the exam room by 8:30) I have her cell phone number and email address (although I’ve never used them) if I need anything at any time. Every time I’m at her office she takes a great deal of time with me (I’m long past post-op issues; this is just regular care) and I have never waited more than 3 minutes in the waiting room. </p>
<p>I know I’m lucky that I can afford the $1500 a year fee but it’s hard to imagine going back to a “regular” doctor ever again.</p>
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The option for me was to pay my doctor a big fee or find another doctor. For my money, I got a comprehensive set of tests I didn’t really need. I never had any problems getting appointments before, and I never felt that my appointments were rushed. I don’t begrudge him doing this, but I don’t think it’s really creating more options for more people. He fired all his patients who didn’t pay the fee, and those he’d only seen a couple of times (like my wife) didn’t even get the invitation.</p>
<p>Shrinkrap–Of course the PAs and NPs need to be supervised by MDs. I just think we have reached a point where every single ear infection or UTI does not need to be handled by an MD and certainly not an MD in an ER. Where many people go because they can’t afford insurance.</p>
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<p>I think the hardest thing will be determining what “requires a physician” and what can “be handled by a mid-level like a PA or NP.”</p>
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<p>I believe part of the training for NP’s and PA’s IS this type of triage. My oldest, becuase she contracted pnuemonia from the swine a few years ago, has vulnerable lungs and now gets bronchitis, for which an inhaler works very well and very quickly. We took her to see a pulmonologist and she has been dx’d by a specialist, AND she knows how this feels in her body early on before it has to be a massive problem. Since the doc office has the records AND the pulmonoligist records, as well, she can be seen easily by a PA for this kind of thing.</p>
<p>Just as an example. For ongoing treatment of recognizable recurring vulnerabilities which have already been dx’d by a specialist, this is ideal.</p>
<p>For a true, original or tricky dx, I’d say an MD. But, we don’t need an MD for a strepp test.</p>
<p>I think one reason people like NPs and PAs is they can spend more time. You feel like you can talk longer with them and ask more questions about your condition. They can often explain things in a more conversational style, so you actually come away with more information you can understand.</p>
<p>poetgrl, I don’t want you to think I’m against moving toward more NP and PA providers because I think they can be an excellent addition to the medical team as a whole. It’s just defining their exact role that remains to be seen…</p>
<p>Slowly but surely we’re getting there…</p>
<p>I was treated by a plastic surgeon who maintains two offices. One is for his private-pay patients and is furnished in a luxurious style. The other is for his insurance patients and is located in a teaching hospital complex.</p>
<p>The reason I know this is that he made a concession to allow me to go to his “private” clinic once when I needed a follow-up during one of his “private” days. I must have looked presentable enough because I overheard him giving his nurse permission to schedule me at his fancy clinic. I used to laughingly think of myself as one of his “riff raff” patients.</p>
<p>I don’t mean to make this into an “us vs them”, but in some states, NPs require no supervision, and in some settings the supervision boils down to signatures. I DO think it’s the future for primary care, but I don’t think “we” will be able to control how it evolves.</p>
<p>Like it or not, midlevel practioners are the future of medicine, especially outpatient medicine. Midlevels are cheaper.</p>
<p>Medicare reimbursement for many specialties approximates cost, while medicaid reimbursement is below cost. In the past, private insurance reimbursement was calculated as a percentage of “usual and customary” fees; private insurance reimbursement is now often calculated as a percentage over Medicare rates. The bottom line is lower reimbursement.
See <a href=“http://www.nytimes.com/2012/04/24/nyregion/health-insurers-switch-baseline-for-out-of-network-charges.html[/url]”>http://www.nytimes.com/2012/04/24/nyregion/health-insurers-switch-baseline-for-out-of-network-charges.html</a></p>
<p>One thing I don’t hear about lately is licensed practical nurses. I once worked at a small hospital in VT that trained its own LPNs and mostly staffed the hospital with them. RNs were charge nurses and supervisors. Maybe it’s no longer “practical” because people in hospitals are so much sicker these days. But the LPNs I worked with back then could handle everything except the medications and I’m sure it was very cost-effective.</p>
<p>^^^^^A lot of hospitals have phased them out, but they are still out there in force in other settings.</p>
<p>I believe in some states they are called LVN’s, (licensed vocational nurse), and I trained as one in high school. Popular in nursing homes IIRC.Back breaking work, but VERY decent income straight out of high school. </p>
<p><a href=“http://en.wikipedia.org/wiki/Licensed_practical_nurse[/url]”>http://en.wikipedia.org/wiki/Licensed_practical_nurse</a></p>