Stanley Feld M.D.,FACP,MACE
The term healthcare provider, in my view, has been constructed to decrease the value of physicians. The goal is to decrease reimbursement and distribute reimbursement for medical care delivered by physicians to others. The physician is now in the same category as the nurse, nurse practitioner, physician assistant, pharmacist, physical therapist, occupational therapist and dietician, to name a few. We are all referred to as healthcare providers by secondary stakeholders.
Several states now permit these ancillary providers to bill independently of the physicians. I believe to treat chronic disease effectively it has to be done as a coordinated team approach with the patient as the most important person in the team and the team leader the medical doctor. Everyone on the team has to have the same focus. The goal is to provide a holistic approach to the patient’s illness and to enable patient’s to become professor of his disease. This is a focused factory. A focused factory team approach to chronic diseases will increase the quality of care given and decrease the cost. The members of the team, the nurses, nurse practitioners, physician assistants, pharmacists, physical therapists, occupational therapists and dieticians should be physician extenders not healthcare providers competing for the patient’s healthcare dollar. A multidisciplinary team approach is essential for the coordination of education and care for the patients with chronic disease. Contradictory instructions given by individual healthcare providers simply serve to confuse patients and not add value to their intensive self management.
The implications, as well as notions, are that these healthcare providers can be physician substitutes providing cheaper care than a physician controlled team. We are presently seeing this trend as Nurse Practitioners and Physician Assistants run Doc in the Boxes in pharmacies and supermarkets for private non medical corporations. The Doc in the Boxes are advertised as centers providing inexpensive, convenient, and rapid medical treatment.
All of the healthcare providers are very important to the healthcare system. However, from a responsibility for care as well as patient safety point of view, these healthcare providers should be called physician extenders and not have equally status to physicians. The compensation for these other healthcare providers should be billed through the physician’s office with physician having the responsibility for effective, safe and quality care. Physician extenders should not have stand alone practices.
These healthcare providers have been licensed by some states to do procedures, examinations and consultations. In the past these duties were the physician’s responsibility. I have doubts about the clinical judgment of these healthcare providers.
The “instant frog” story is appropriate. It takes two weeks to hatch a frog from a tadpole. If you put a tadpole in a petri dish and put thyroid hormone in the petri dish, you can produce something that looks like frog in thirty six hours. This analogy can be applied to healthcare providers who have not had the breath of education, experience, and time to develop the clinical judgment that physicians have had. Therefore it is unwise to equate an instant healthcare provider to a fully developed physician.
If these “Doc in the boxes survive, we as a society will be making a great mistake. As a society we have invested a great deal of money in developing our physician work force. Today, Family Practitioners are having a hard time surviving. They are not permitted to produce income generated from ancillary services for their intellectual property on the one hand, and are being challenged by healthcare providers who are compensated for private practices on the other hand.
We as a society do not realize it yet but we are about to destroy a precious resource for the sake of the corporate bottom line. If physicians are inefficient in the delivery of care, we ought to teach them how to deliver efficient care and not destroy them. If we do, we are destroying 6-8 years of graduate education and the clinical judgment developed in that process.
We need to rethink our present path.