It’s my pleasure this week to welcome a guest post from Dr. Vance Harris, a family doctor who practices in Redding, California. Dr. Harris makes some excellent observations about two aspects of ObamaCare related to expanding the role of nurse practitioners.
The first is that giving NPs the privileges and responsibilities of actual physicians will somehow magically be separable from having them take on many of the same characteristics that our political Leaders are so quick to criticize in doctors. These include having to practice expensive defensive medicine, becoming the object of politically-inspired suspicion and fear, and havingthe audacity to ask to be paid for their work. What medically unsophisticated supporters of government-guided healthcare like Peter Orzag seem to miss, is that people in healthcare behave the way they do because of incentives and disincentives. If you place different sets of faces into the same dysfuntional situation, they will tend to take on the same business characteristics as those they are replacing.
The second aspect is the blind assumption that, because NPs have lower nominal salaries than physicians, they cost less to use. This is the sort of basic mistake that people make all the time with respect to medicine – they miss the concept of economic productivity. If you call a nurse a doctor, that doesn’t mean that he or she will perform like a doctor. Their education and training is very different. Why would you expect that they will be equally expert, efficient or versatile in a physician-type clinical practice where anything and everything can come through the door?
I also wanted to take this opportunity to salute Dr. Jame Gaulte and his retired doc’s blog for his recent post entitled:
ACO and HMO, A distinction with or with/out a difference – Are ACOs an example of Underware Gnome Economics?
You have to love posts like this that are both humorous and brutally accurate.