[NPInfo] An answer to the HealthLeaders article. See below.

[Donna Alden-Bugden]

Hey Dave..Have you been a PA since 1975??  Wow...you look so young to have
been in the field for almost 40 years!!!

I wish Canada could say that we have had NPs for that long...let alone PAs .
We just started regulating the NP in the last decade...and the PA is really
a new addition and it is not regulated in some of the provinces.

Donna 

*******************************************************************
Donna L. Alden-Bugden, BScN, RN(EP),  MN (ANP), DNP-S
NPCanada.ca - Promoting Nurse Practitioners in Canada
Nurse Practitioner & Emergency Nurse
Winnipeg, Manitoba
Doctoral Student - Cleveland, OH

Donna at Alden-Bugden.ca
Alternate E-mail: 
Donna at NPCanada.ca
http://www.NPCanada.ca 
*******************************************************************





-----Original Message-----
From: David Mittman [mailto:dmittman at comcast.net] 
Sent: November 12, 2007 17:49
To: ACC Listserv; PAForum at mc.duke.edu; NPinfo
Subject: [NPInfo] An answer to the HealthLeaders article. See below.


ADVOCACY!

Dear Rick: 
I respectfully want to comment on your recent article entitled, ³Looking
Upstream² that ran November 8th in HealthLeaders. In reviewing changes that
you feel will hit healthcare system over the next few years, I actually
agree with most. One prediction hit me as being awfully one sided in it¹s
view. That was the one titled ³Family Docs Will Step Aside². While I also
agree with what you said about that prediction, I have to point a few other
thoughts out. I am a PA who graduated my training program in 1975. I have
been involved in medical politics for almost 40 years and have lived through
many changes to our healthcare system. NPs and I might add PAs (whom you
omitted) have been providing high quality primary care for decades. There
are about 100,000 in the primary care specialties and another 80,000 spread
over a large number of other specialties. The fact that we already provide a
large portion of primary care to the citizens of our country is not new. We
are not interested in ³taking over² primary care, just the acknowledgement
that both professions are already providing a considerable share of it. Also
that both professions do bring something to the table regarding the future
of medical care and what we bring, may in fact, help to save primary care.
Why? Because as you pointed out, physicians generally do not want to
practice in the primary care specialties any longer. They are making this
decision with their feet. Many physicians are looking at medicine¹s future
and seeing PAs and NPs as a solution to a number of the inequities seen in
today¹s system. We would ask that the larger organized physician groups
start to view us not as competition, but as colleagues who want and value a
relationship with them where we are given recognition as valuable
professionals. We will be glad to give that recognition and support back.
All one has to do is read a few articles on the retail clinics where
organized medicine has made unprofessional remarks telling patients we will
³miss things² or that we don¹t ³know our limits². Statements like this show
that these groups are not ready to provide a comprehensive solution to this
mess we call primary care delivery, as they will have to work with and
recognize PAs and NPs (as hundreds of thousands of their members do now), to
have these changes succeed. They should realize statements like those only
serve to drive away the very groups they need to be closer to. My last point
would be to ask why you see the increasing use of NPs and PAs as a negative?
To quote the article, ³I'd be especially interested in any predictions that
are favorable for healthcare. Those are pretty hard to come by². I think
prediction number two is quite positive and am surprised that as a health
leader it appears you do not feel the same.

Sincerely,
Dave Mittman, PA
Secretary 
American College of Clinicians
Natick, MA

> Looking Upstream
>  
> Rick Johnson, for HealthLeaders News, Nov 08, 2007
> 
> Over the past few weeks, I've been on the road at conferences and 
> meetings talking with healthcare administration and physician leaders. 
> In my conversations with these industry experts, I've asked them to 
> forecast changes that will have the most impact on physicians. Here 
> are five predictions for the near-future:
> 
> 1. Small practices will perform a disappearing act. We're already 
> seeing many solo and small physician practices close shop. Many of 
> these join large multi-specialty groups that can negotiate with 
> payers, gain operational efficiencies of scale, and better afford 
> capital investments. Simply put, costs are too high and reimbursement 
> is too low for mom-and-pop shops. Expect this trend to 
> continue--especially as more experienced doctors look to sell their 
> practices and fewer emerging physicians look to start their own.
> 
> 2. Family docs will step aside. In the October HealthLeaders magazine, 
> our cover story investigated what's often referred to as the "looming 
> physician shortage." Many regions are already feeling the impact of 
> this shortage. With family physicians taking the biggest reimbursement 
> hit over the years, we're seeing fewer new physicians entering primary 
> care. Since the need isn't going way, patients are getting care from 
> nurse practitioners--in the office setting as well as retail clinics. 
> One chief medical officer told me recently that he thinks family 
> physicians will someday be a profession of the past. He said NPs are 
> already providing primary care--and in many cases they do it better.
> 
> 3. Hospitals will keep hiring physicians. One development in 
> healthcare that I find somewhat surprising is how quickly hospitals 
> have taken to hiring physicians. No doubt necessity has required 
> hospitals to break from the traditional medical staff model. 
> Hospitalists have proven effective at improving quality of care and ED 
> throughput, but now many administrators are bringing on orthopedic-, 
> neuro- and cardio-traumatologists. The upside of these specialists has 
> been widely reported, but one potential downside is that independent 
> physicians have fewer reasons to enter the hospital. While the rise of 
> the hospital-based physician might improve coverage, quality, 
> efficiency, and the lifestyles of the medical staff, are they also 
> creating another barrier between independent docs and the hospital?
> 
> 4. Patients will continue to foot more of the bill. Big employers keep 
> grumbling at the high cost of healthcare. And some have been 
> predicting alternative coverage models for years. Even if you don't 
> buy into the healthcare consumerism movement, the fact is that copays 
> keep climbing. With more of their own money as stake, patients are 
> going to become more selective and demanding about their healthcare 
> purchases. Not only will medical groups need to react to these fickle 
> consumers, but they'll also need good systems in place to be sure 
> patients pay their bills. Collecting from third-party payers might 
> seem like a chore, but consider the challenge of chasing down 
> individual patients.
> 
> 5. Fewer doctors will take Medicare, Medicaid, and charity care. We've 
> heard this one a few times, haven't we? It seems like whenever 
> Medicare releases the physician fee schedule, the major physician and 
> medical group associations warn that docs will stop accepting Medicare 
> patients. Now practices face a 10.1 percent payment cut with 
> Medicare's release of the 2008 physician fee schedule. Last week at 
> the MGMA conference, I spoke with the association's president, Bill 
> Jessee. He talked about how reimbursement declines are affecting 
> physicians and how he thinks practices will respond. Doctors today 
> have to deal with the high cost of running a practice and lower 
> reimbursement. Factor in that many are practicing in large 
> multi-specialty groups and hospitals. What you're left with are fewer 
> physicians in the community who can afford to care for uninsured and 
> underinsured patients.
> 
> I didn't intend for this list to seem so dismal, but these are the 
> things I've heard as I've been on the road the last few weeks. If you 
> have comments, questions, or concerns about what my sources are 
> saying, please drop me a note and correct me. I'd be especially 
> interested in any predictions that are favorable for healthcare. Those 
> are pretty hard to come by.
> 
> 
> Rick Johnson is a senior editor with HealthLeaders Media. He can be 
> reached at rjohnson at healthleadersmedia.com.
> 
> 


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