A thought on Healthcare reform, part 2

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...2. Let midlevels have more independence: This is exactly what the Nurse practitioners want to happen. They have been spewing out shitty study after shitty study proclaiming they can perform primary care just as well as a physician for years. Now, they have invented a new degree so they can be called "doctor," the DNP (see my prior posts about the DNP), to further blur the lines between nurse practitioner - a mid-level practitioner position - and physician. The problem with this, aside from everything, is they do not know what they do not know. I blogged once about how one cannot recognize something unless one is familiar with it. This is the perfect example of how true that statement is. Aside from that, cost of care often goes up when midlevels are involved, as they are more likely to refer to more specialists and perform more tests.

Never mind the can of worms opened up if we officially say that primary care can be adequately performed in all circumstances by midlevels who are not as well-trained as physicians.

3. Pay physicians and practitioners less. While this may reduce some costs, reimbursements to physicians and practitioners are a relatively small portion of healthcare dollars (only about 20 percent of all healthcare spending went to physicians AND clinics in 2007). While some may bring the argument that physicians in the U.S. make more than their counterparts in other countries, the fact is that in other countries, the educational requirements are less (most other countries start medical school immediately after high school, lasts only 6 years) and physicians in many other countries do not have such high debt loads, if any (medical school in many other countries are government sponsored).

Currently, I have over 150 thousand dollars in debt and am making payments of about $750 per month (more than my rent) on a 49 thousand dollar a year salary. I will be about 60 when it is paid off, if I pay it off at the rate my loaner wants me to pay.

I am 13 years out of high school, have 9 years of post-high school education, a doctorate degree, am starting my fourth year of residency, and make less than people with 1/3rd of the education, have more debt than many people make in nearly a decade and make life or death decisions every day.

In addition, in my particular specialty (Emergency medicine) there is an unfunded mandate (EMTALA) that I evaluate any person who walks in the door, regardless of if they can pay for my services and time. On average, every Emergency physician provides over 150 thousand dollars per year in unpaid care under this mandate. How much should my pay be cut when I already "donate" so much care a year?

While I don't know what the answers are, I can tell you what the answers are definitely not. This is what we are going to have to find out before we can fix our broken healthcare system.

I'll post more on this in the future, as we move forward.