Universe On The Couch

US News has a whole feature this week on basically replacing physicians with lesser trained health care professionals. Don't expect me to not get emotional here. Today I focus on nurses.

The gist here is to replace doctors with nurses. You may have experienced this already. You go through all the hassle of scheduling an appointment with you doctor, take time out from your busy schedule, the hassle of driving there, paying to park, waiting in the waiting room,... Only to be told the nurse will be in shortly. I wouldn't bother coming in unless I was concerned enough to deal with it myself.

Nothing against nurses. They provide an essential service. It is often physically hard work and often unpleasant. They work at all hours on their shifts including when most of us sleep or have time off.

But let us first look at qualifications. One can be an RN with a two-year program. To practice medicine it takes four years of college. And that at a performance level good enough for the very competitive admissions process to get into medical school. Then four years of medical school, very rigorous indeed. Then at least an internship for a year. Grueling to say the least. Most finish a residency of at least three years, usually more. Who would you want?

So who would want to replace doctors? Let us start with nurses. The profession has a severe shortage of people doing actual nursing. This is funny in that the profession is overloaded with administrators. I saw this top-heavy more chiefs than Indians in the military and in hospitals everywhere. And with salaries pushing six-figures too. So they are pushing with their powerful lobbies to practice medicine. Sounds like ego and money to me.

The second culprit is insurance companies. Pocketing great profits screwing over the doctors and patients. Now they can pocket more money using lesser providers.

Third is the drug companies. More providers means more drugs prescribed.

Fourth is the government. They see the current costs of care and want easy solutions. Of course Congress will always go to Bethesda and be cared for by the top doctors.

Will this really save money? In the short term perhaps. Manipulated statistics will show positive results. But they will be misleading. Expect more bad medication outcomes given the nurse's limited pharmacologic knowledge. Sure they can probably handle 80-90% of the problems if further training is adequate. But what if you are that 10-20%?

There is also the over-reliance on expensive tests. When nurses played dermatologist all cost savings were lost because they biopsied everything, also uncomfortable and not without risks to the patients.

Is this the way to solve the nursing shortage? No way. Less nurses practicing nursing. The migration from the Philippines is causing huge problems there. Salaries are now quite high. It is not a bad deal to be a nurse when you figure the time invested vs. Benefits when you graduate.

In summary, replacing doctors with nurses:

1. Will not save money .
2. Will decrease the quality of care.
3. Will put patients at risk.
4. Will worsen the nursing shortage.