Dr. Rosen: What do we think about the news of an insurance company combining with a retail pharmacy company to deliver healthcare and not have any of us in the set up?
Dr. Edwards: Don’t you think insurance companies feel they can do much better without physicians?
Dr. Milton: I’m sure they think they can do better with nurse practitioners.
Dr. Ruth: My experience with NPs is that they order a lot more tests which increases the cost of healthcare greater than the amount saved in physician salaries. It’s as if they believe if they order enough lab tests, the lab can make the diagnosis for them.
Dr. Michelle: I agree. Physicians must have a tight arrangement with NPs and especially with PAs to control their costs.
Dr. Milton: I would have to agree with both comments. Neither have gone through the rigors of medical education. But I would feel more comfortable with NPs since nursing education in large part parallels medical education.
Dr. Edwards: I think insurance carriers will be surprised if they think they save money. I agree with Dr. Ruth that the NPs order more tests. I just don’t think they have the diagnostic acumen that physician have.
Dr. Rosen: There probably are a couple of reasons for that. They normally have two years of clinical experience, but I understand there is a movement to have NP training increase to four years of post RN graduate work. But I don’t foresee free standing RN hospitals for the in-depth training apart from physicians.
Dr. Yancy: However, the nursing lobby as manifested by their state and national professional organizations has deteriorated into union organizations and even go as far as striking.
Dr. Ruth: What has always struck me as being unfortunate is why nurses feel they can improve their status by turning to law makers who in large part are attorneys? They feel they can improve on the nurse/patient ratio through law, and law does not understand either nursing or medicine.
Dr. Sam: Well, medical organizations in other countries have deteriorated into unions. The British medical association is effectively a trade organization.
Dr. Dave: The national health service in the UK is a prime example of how a health system deteriorates when they are under the thumb of politicians. It changes as politicians are not re-elected; but, unfortunately, the next politician’s thumb is just as green and ignorant as the previous one.
Dr. Kaleb: That’s something the public doesn’t understand. Every change in political electives or appointees, brings a new interpretation of the practice unrelated to any solid medical evidence. I remember discussing this in my country. Different groups of doctors benefited from different politician’s perspectives. I remember an allergist telling me his business mushroomed because of this change in emphasis. He found out later that the minister of health had a child with asthma and he wanted to be sure that all asthmatics had the highest level of care. So special tests in the allergic fields were always automatically approved.
Dr. Patricia: It reminds me of the three blind men trying to describe an elephant. They only understand what they can feel: the leg, the trunk, the ear, the tail or the chest. They never understand what the elephant looks like or how he operates. The public doesn’t have any understanding of how health care operates. Some think changing the modus operendi of the ER will solve everything; others think helping the poor dumb physician make the diagnosis will solve everything. If we could only improve the quality of health care that the 12 years of medical education somehow missed. Why do we allow these medical illiterates to tell the medical profession how to practice medicine?
Dr. Joseph, Ret: I think my generation provided excellent care without all this government interference. And with just the basic 5- to 8-years of medical education.
Dr. Rosen: You may be right. But things will never return to a previous state. They will just laugh at you without any understanding of where the doctors are coming from. The public also believes that physicians have no understanding of modern health care. It’s a dilemma that can’t be resolved by debate or logical argument. The liberals will always think they’re right and we are wrong. There is no common meeting ground.
Dr. Joseph, Ret: But we have to be careful about all doctors being conservative and constitutionally oriented. Many physicians have turned to government as being the source of all that’s good. Some doctors even testify in Congress now and think members of Congress are logically inclined and work in our patient’s interests.
Dr. Rosen: There is another side to this argument. It’s more serious that a dilemma that can’t be resolved by debate or logical argument. The liberal doctors have been hoodwinked into thinking that they are now on par with politicians. But this doesn’t improve politician opinion of our profession. They still think we are naïve about healthcare. So the liberal politicians still don’t trust the neo-liberal physicians, even those “enlightened pseudo-progressives” will continue to think they are on the same wavelength as politicians. Therefore, nothing has changed, and the liberal politicians continue to win—thinking that all doctors are either wrong or just simply too biased about what they do that we still need their help in the practice of medicine
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