Let’s talk Healthcare Reform.
Don’t get discouraged, and please don’t leave. We’re going to stay away from the Red vs. Blue rhetoric, and (hopefully) neither side will be called a bunch of loons. Since we’re friends, you and I, we’re just going to take a look at something we really need. If we don’t fix this problem, any healthcare system could come crashing down like a house of cards.
Most of the plans being discussed formally establish a “Medical Home” for patients. We can go see any doctor we choose, but the Medical Home system would establish a Primary Care doctor as our automatic first stop – we see him/her first. If we need specialized care, they’ll refer us to a specialist. Chronically ill patients need a primary care doctor anyway; I write often about finding a good Cardiologist, and that is important, but life happens. CHDers turn ankles and slice our fingers while chopping onions just like everyone else. We need a Primary Care doctor for those times when the problem isn’t heart related.
Problem is, for the Medical Home plan to work, we need more Primary Care doctors. We’ve got a shortage on our hands now, so much so that older doctors can’t retire. They aren’t paid as much, so more doctors choose to be specialists. The Primary Care docs we have are already being asked to work harder and harder; some of them are choosing to relocate to facilities where the pace isn’t so frantic. One of the reasons the Universal Healthcare system introduced in Massachusetts is in such trouble is the shortage of Primary Care doctors. The system is simply being overwhelmed.
Even if we could somehow make Primary Care the most attractive job in the world, we’d still need six years or more before the number of new doctors would begin to climb. One way to deal with the problem now is to expand the role of Nurse Practitioners. NP’s are nurses, but they have had extra training and often have Masters degrees. Some states already allow a Nurse Practicioner to diagnose and treat patients; they can even prescribe medication. Some states don’t.
We need Federal legislation to get all the states on the same page, with a national standard of care. Then we can talk about Universal Coverage, insurance, coverage, and who pays. But let’s fix the doctor shortage problem first.