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No Physician Shortage

December 5, 2013 | No Comments
Posted by Frank Ciesla

In today’s New York Times (December 5, 2013), a guest editorial by Scott Gottlieb, an internist and fellow at the American Enterprise Institute; and Ezekiel J. Emmanuel, the former health care policy advisor to the Obama Administration; representatives of both the right and the left, argue that there will not be a doctor shortage due to both the growth of technology as well as the shifting of care to limited licensed personnel, such as nurse practitioners, health aides, pharmacists, dieticians, psychologists, and others.  This reference to the expansion of the provision of services by limited licensed individuals, has been referenced previously in our blog ( of October 10, 2013, discussing the issue of the standard of care that will be applied for malpractice as well as the reimbursement when the care is provided by such limited licensed provider.

As they state in the article “that means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care, changing laws inhibiting telemedicine across state lines and reforming medical malpractice laws that force providers to stick with inefficient practice simply to reduce liability or risk.”  Further, the article states that “new payment models must reward investments in technology that can save money in the long run”.  The bottom line is that “most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.”

The relationship between the patient and their physician obviously will be radically changed in this environment.  We are already progressing towards that radical alteration of the relationship in the expansion of the state statutes regarding limited licensed practitioners as well as in the creation of new delivery systems, such as the ACOs, whether they be ACOs under the Affordable Care Act, ACOs under State Medicaid laws, or ACOs created by third party payors or in conjunction with third party payors.

This probably is necessary to reduce the cost of health care, since the cost of educating physicians must be recovered one way or the other, in the cost of providing health care.  It is obviously less expensive to educate a nurse practitioner, a physician’s assistant or other limited licensed practitioners.  In the future, it may be that you can keep your doctor, but you will rarely see your doctor.  You will be treated primarily by limited licensed individuals.

This projection as to the future must be considered by all providers, whether they are physicians or other limited licensed individuals or licensed hospitals, clinics, etc. in structuring and investing in how they will deliver care in the future.  One of the key questions going forward will be, will you be able to recover the investment and some return on that investment under the payment system that will evolve?


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