Ignorance Is Bliss

From the comments section comes this juicy tidbit:

 AAA said...

I agree with the notion that MDs are no longer needed in primary care settings. Physician Assistants or Nurse Practitioners could do this job as well or in many cases better than MDs. Increase the number of Nurse Practitioner Programs and PA programs and decrease medical schools to a handfull number. That would solve our escalating cost in health care, and provide patients with a higher quality of clinical and caring care.

When taken to AAA's blog,  Botanical Medicine Posts...

It's an interesting theory.  A theory filled with holes.

1. Physicians are focused more on how to handle filling for insurance, avoiding law suits for malpractice, and how to see as many patients in a 10-hour shift than really caring for their patients.---The assertion here is that somehow nurse practitioners would be immune to these forces.  AAA, how would a nurse practitioners run their office without filing for insurance.  How would they avoid lawsuits.  And how would they pay their bills without seeing as many  patients as possible?  If there is a magic NP business model that somehow is able to evade all these problematic issues of outpatient comprehensive care, I would certainly love to see it.   
2. A new breed of clinicians is being surfaced in USA where Nurse Practitioners and Physician Assistants are as competent in disease management as any physician.--Do you believe that the medical trained boards of internal medicine, family medicine and pediatrics are therefore unnecessary?  
3. They are willing to spend more time with patients without worrying about managing a business.-How is it that nurse practitioners don't have to worry about managing their business.  Is there a nurse practitioner fund that will bail them out when their business bankrupts from not seeing enough patients.  How is that many comprehensive care doctors need to see 30 patients a day to earn the same amount as many salaried nurse practitioners these days.  Is there some magic money tree that will pay the NPs bills?
   
4. Perhaps the model for health care in the immediate future is clinics staffed with NPs and PAs and one physician who is just hired to manage the clinic, but not to see patients.-What?  Did the really expensive physician just become the business manager?  That seems like the worst business model ever.
   
5. This will save cost and gradually eliminate the health insurance system. Patients want more caring clinicians and less business like providers-Saving cost?  Perhaps.  Unfortunately, the cost of the comprehensive care physician in the grand scheme of the 2.3 trillion dollar health care business is minuscule.  If you think trading out NPs for MDs will 'save cost', you fail to understand the grand scheme of expenditures.  What about the other 2.25 trillion dollars in expenditures not related to the fees of comprehensive care doctors.  It's easy to write about the front end cost savings.  It's easier to ignore the back door expenses of this model.  You can't be a caring provider if your office goes bankrupt.

I am amazed, really amazed at the lack of knowledge displayed by those in the lay public when it comes to the realities of providing care to patients.  This  botanical medicine person appears to live in some sort of economic black hole where the rules of revenue and overhead expenses only apply to some populations but not others.  To believe that a NP could operate a clinic independent of the financial and legal concerns that is currently crushing outpatient comprehensive care physicians, is to show a total lack of understanding or desire to education oneself on the process.