There was a recent article in the Sunday newspaper about the upcoming shortage of primary care physicians. Although this article quotes an anticipated shortage of up to 55,200 primary care physicians by the year 2032, I’ve seen other studies that quote bigger numbers, upwards of 100,000 by the year 2030.
There’s lots of reasons why this is happening. Student loan debt for the average medical student is often in the neighborhood of $200,000, with over 25% of students exceeding this level of debt. While our college buddies are finished with school in four years – or six, if they move on to a master’s degree – many times it’s several more years before any true earning potential emerges as we slug out the physician training protocol of internship, residency, and often fellowship.
No doubt, the changing face of medical insurance and reimbursement, in general, has influenced many individuals to shy away from medicine, and – in particular – primary care medicine. We’ve all seen these arguments and concerns and noted their increasing frequency in the news.
It’s no secret that documentation via electronic medical records has become a huge thorn in the side of many physicians. It’s not uncommon for physicians to spend multiple hours a week in non-clinical duties, just documenting well-baby visits, or normal lab findings. In fact, some studies report that primary care physicians spend more than half of their “clinic time” documenting in the charts, rather than in actual patient care.
None of these reasons will surprise you, as you add up the list of why less people are going into medicine these days.
However, there is one elephant in the room that is not always acknowledged. I saw it, buried near the end of that page long Sunday newspaper article about physician shortage.
According to a health policy analyst at Boston University – and I quote — “[O]ne way to keep and attract primary care doctors might be to shift some tasks to health care providers who aren’t doctors, such as nurse practitioners or physician assistants. The primary care that they provide compared to a physician is just as effective.”
With all due respect to our healthcare team, I beg to differ that going through four years of college and completing an additional two years – sometimes online, no less – can truly be “just as effective.”
The average training for a nurse practitioner is 6 years compared to an average physician training of 11 years. Certainly, none of us are infallible. No matter how much education we have. However, just like more seasoned physicians are typically viewed as having more wisdom, one could surmise that a difference in 5 years of training, from the start, should count for something.
I’m not arguing against having the support of other healthcare members. Trust me. The shortage is real. And we need to find solutions.
But please don’t say, we are “just as effective.”
I realize that there are many duties that nurse practitioners and physician assistants can do with skill and authority. And the reasons why primary care physicians are declining is multifactorial, for sure. As I see it, though, putting physicians and our skill side-by-side, on equal footing, with those who are not physicians only serves to drive a deeper wedge between the healthcare folks who need, at this crucial time, to come together.
Starla Fitch, MD, is an ophthalmologist, speaker, and personal coach. She blogs at Love Medicine Again and is the author of Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine. She can also be reached on Twitter @StarlaFitchMD
Many NPs are former nurses with 10+ years of experience in patient care. Many of us have worked in ICUs saving the lives of patients poorly managed by physicians. Don’t blow yourselves out. I’ve been an NP for over 25 years. I work beside MDs who don’t give a shit about their patients. They’re happy to give the sicker patients to us to manage because they are so burned out. Your rhetoric is a bunch of BS.
You bring up a point that is critical to us. Nurse Practitioners TODAY do not need any prior nursing experience. None. They can enter NP school directly out of college (with any degree, not a nursing degree), then get their RN degree and proceed directly (in the same online program) to an NP degree in less than a total of 2 years. Oh, and that clinical experience you tout?? Today’s NPs need as little as 500 clinical experience hours–and those can be shadowing hours. So, today, we have Nurse Practitioners with no nursing experience and minimal clinical experience who expect to treat patients independently. Patients and legislators have no idea about this atrocity, but we’re teaching them.