LB Health Care Reform Town Hall Sobering

I was invited to speak at a town hall on health care reform sponsored by St. Mary Medical Center. Congresswoman Laura Richardson and several other speakers also talked about the need to reform our current health care system.

While most of the speakers focused upon changing the financing of health care, I spoke on the need to deal with the delivery system.

Below are some of my remarks:

"As the first Registered Nurse Practitioner to sit on the Medical Board of California, the agency which licenses and disciplines the 117,000 plus physicians in my state, I need to share with you my perspective on how the current health care system is taking its toll on these physicians and putting the medical profession at odds with the nursing profession and how if these problems are not addressed, we will not be able to ensure that every American has access to health care.

More and more doctors say they want to leave the profession in the next few years. Many others say they wouldn’t recommend the profession to their own children. The suicide rate among male physicians is 40% higher than among the general male population and 130% higher among female physicians than among the general female population.

Those who remain in medicine are mad as hell.

Who can blame them? Doctors are under constant attack from about everyone, for trying to do what they spent many years in training to do.

Doctors note that they are no longer the “captain of the ship” in health care. The medical profession no longer provides the autonomy nor the prestige once given, as insurance companies pay doctors pennies on the dollar for the care they provide and managed care company clerks place limits on the type of care they can give. Doctors spend too much time filling out forms and focusing upon billing problems; time that could be better spent with their patients or their own families.

They agonize as they watch helplessly as some of their seriously ill patients struggle to get insurance companies to cover their health care needs or to pay for the prescription medicine that could save their lives.

The government tells doctors whom they must treat and fines them if they don’t. Patients sue when they don’t like the outcome of the care they receive resulting in malpractice insurance coverage costs taking more of their income.

We began having a shortage of physicians in this country beginning in the 1980’s -- just about the time managed care arrived and began undercutting how doctors practice medicine. To fill this shortage, my own profession provided advanced clinical training for nurses who became nurse practitioners. Although paid far less than physicians, nurse practitioners nonetheless provide primary care in many health care settings.

Many physicians perceive expanding the “scope of practice” of non-physicians to allow health care professionals such as nurse practitioners to diagnose, treat and prescribe, as a further attack on the status of medicine and are waging battles in several states to stop the expanded authority of nurse practitioners. This despite the fact that most studies show that nurse practitioners can safely and effectively provide 80% of all primary care.

The medical community recently sounded the alarm against the a new “Doctor of Nursing Practice” that moves nursing in the direction of other health professions such as medicine, dentistry, pharmacy, psychology, physical therapy and audiology which all offer clinical practice doctorates.

Expanded scope of practice for non-physicians has been the only means of meeting the need of providing access to health care in many communities.

We need to bring the medical and nursing professions together to discuss how we can work collaboratively to expand access to patient centered primary care in this country.

In some health care settings, that may involve physicians and nurse practitioners working in “multidisciplinary teams” with the “understanding of the distinctive roles, skills, and values of all team members” – as the American College of Physicians just stated in its policy monograph about nurse practitioners in primary care.

But it may also require that in some health care settings, nurse practitioners substitute or replace primary care physicians in order to provide access to primary health care; a possibility that the American College of Physicians strongly opposed in the same monograph.

This independent role of nurse practitioners (which is already allowed in several states: AK, AZ, DC, IA, ID, MT, NH, NM, OR, WA) obviously requires acknowledgement that appropriately trained nurse practitioners can safely and effectively provide such care and that they can access other health care resources such as admitting privileges at hospitals, adequate malpractice insurance and equitable reimbursement for the care provided.

Our health care system must acknowledge and value that each profession, by its training, has a different focus on patient care. Nurse Practitioners are often sought by patients because of our abilities to spend more time with patients and our holistic approach in caring for patients and their families. Physicians have extensive clinical training and experience and are consulted when the patient’s condition requires advanced care. Using a combination of medical and nursing professionals expands the sources of care in all communities.

Medicine and nursing must not be at war with each other over whom should care for patients, especially at a time when such care is so needed in our country.

We need to bring about a change in our health care system that not only benefits patients but those who provide the care."

Note: My remarks are my own and not to be construed in anyway as reflecting the California Medical Board.