(September 23, 2010)
Since the government is going to take more control of the healthcare system in the US (despite all their claims to the contrary), you’re going to see more and more cost cutting measures in the delivery of healthcare to everyone. One area where changes are going to take place is the expansion of procedures allowed to be performed by nurses, technicians, and other para-medical providers.
What brought this to my attention was the discussion in Colorado recently where the Governor, Bill Ritter, was trying to decide whether or not to opt out of the Medicare guidelines, which requires nurse anesthetists to work under the supervision of a physician. In 2001, the Centers for Medicare and Medicaid Services (CMS) instituted a rule in the Federal Registry that permits a state to be exempt from Medicare’s physician supervision requirement for nurse anesthetists with approval by the state governor. So far, 15 states have opted out of the federal requirement, instituting their own state requirements instead.
I’m not questioning the competency of the nurse anesthetist’s abilities to administer anesthesia within the scope of their practice. Nurse anesthetists are licensed to practice independently in each of the 50 states, though the scope of practice does vary from state to state. My point is: Now that the government will be footing the more of the healthcare bill in this country, there will be more procedures allowed by non-physician providers, to try to contain medical costs. This effort will have its affect on physicians and patients both, and neither of them positively.
For physicians it will cut into the income levels by allowing lesser qualified medical personal to make medical decisions that have previously been permitted only by licensed physicians. The argument that will be used by the government will be that many rural and inner city hospitals have difficulty recruiting doctors and specialists to adequately serve the medical needs of the area population. By allowing nurses and technicians to perform certain routine medical procedures, the public will have access to more medical treatment, and the public will benefit. I have no problem with this logic, up to a point. While routine procedures and treatments can safely be performed by aids, nurses, or technicians, the person best qualified to make medical decisions is still the doctor. Medical Doctors are the only members of the medical team qualified and licensed to diagnose. If, and when, non-qualified personnel are allowed to diagnose and initiate treatment protocols, then the likelihood of increased problems will occur.
For patients who are not examined by physicians, but are diagnosed and treated by non-physicians, the quality of care may not be the quality of care that they have come to expect. In most instances the diagnosis and treatment may be straight forward, but in the occasional case where the diagnosis is not so straight forward, or the treatment is not typical, the patient care will suffer. Patient care will suffer if the scope of practice for non-physicians is expanded without requiring increased educational criteria. There is a reason why all 50 states require doctors to be licensed, and that reason is to ensure quality patient care. The patient will certainly care who treats them, if they are misdiagnosed or mistreated by a non-physician. If the patient is not allowed to be examined or treated by a medical doctor due to budgetary constraints, then who is liable for any malpractice, if any occurs? The doctor, who didn’t examine and treat the patient, because this has been ‘usual and customary’ or the non-physician who examined and misdiagnosed the patient? Will malpractice insurance decrease for the doctor, because they are not treating as many patients, or will it increase because the doctor is liable for the actions of their staff?
When healthcare gets rationed because of the healthcare reform bill, where will the liability fall as patient care decreases, yet patient expectations become greater, because of the promises made by the politicians during the healthcare debate? As a physician in private practice you need to be aware of the assaults coming at you from all sides. In today’s political climate; only the greedy insurance companies are a bigger villain than the greedy doctors in the healthcare field.
Just trying to keep you informed on all the attacks that the private practice physician will be facing in the coming years.
Submitted by Dr. DG Comfort, CO
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