[NPInfo] Re: Retail Clinics again

[Tracy Klein]

OK its time to move on from this topic. However, I
note with irony that what happened in this discussion
is exactly what I asked in the original post not to
occur which is, quit spending time trying to analyze
why MDs are upset or why they are threatened. Start
analyzing what you are going to do about it and talk
to the media yourselves, do your own research, or
write your own articles. Don't permit the AMA, AAFP,
and whomever to be the voice that gets quoted.
Ive now been interviewed a number of times because of
my Medscape article. I dispute the contention that the
media won't talk to you. They won't if they do not
know you are not there, so that, indeed is your job
and no one elses.
And, as I said in the original email, I think Jeff's
letter is right on the mark. And, I still support the
retail clinic model if done appropriately. Its a good
service for patients. There is no "medical home" in
America right now. That term, by the way, was invented
in the mid-90s to reframe denial of care by the HMOs
to appear to be an altruistic, paternalistic measure
to keep the kids at home. Dang it how those kids grab
the car and go out looking for illicit health care
anyhow.
Tracy Klein, WHCNP, FNP
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> Today's Topics:
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>    1. Re: Re: Jeffs letter (Jeffrey Hazzard)
>    2. Re: Re: Jeffs letter (David Mittman)
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> 
> Message: 1
> Date: Mon, 3 Sep 2007 02:18:50 -0700 (PDT)
> From: Jeffrey Hazzard <jeffnp27 at yahoo.com>
> Subject: Re: [NPInfo] Re: Jeffs letter
> To: NP Info <npinfo at nurse.net>
> Cc: Judy Wightman <norjud80 at yahoo.com>
> Message-ID:
> <222976.13160.qm at web31302.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
>    Carla (and Tracy),
>    
>        I never wanted to be patronizing.  I regret
> that I may have come across that way.  
>    
>        Yes, the corollary to what I wrote is that
> the patient is given more choice and selection from
> which to decide how to obtain health care.  You're
> right on the mark there.
>    
>       And I agree that family practice physicians
> don't like to see their fellow physicians in the
> retail role much more than they do us NPs and PAs. 
> The one difference is that they know that if
> physicians can keep NP/PAs licenses tied to
> physicians, then they can keep NP/PAs tied to
> physicians economically, too.  The idea is to keep
> us invisible.  What worries the physician
> strategists with insight the most is our clearly
> autonomy when we sit in a retail setting by
> ourselves.  There is a presumption of dependency
> that is perpetuated by inuendo when we work in a
> physician-run office.  A subtle suggestion is given
> to the patient that a physician is always there to
> "review" of our work.  Patients are never
> discouraged from believing "the doctor looks over
> everything the nurse does to make sure it is done
> right."
>    
>        When the only person in the clinic is a nurse
> practitioner, the autonomy is hard to hide.  This
> realization strikes fear in the hearts of the docs. 
> They see a slippery slope--unless we are quickly
> caged up, we might expand our scope of practice and
> chip away at their office business.  To counter this
> they have been promoting the "medical home" theme
> hard.  And they make pronouncements of what we can
> and cannot safely do.  
>    
>       Remember, say it enough times and it becomes
> fact.  We need to counter the lies and half truths
> forcefully every time we hear them, or the half
> truths will become facts, evidence be damned.  
>    
>           Jeff
> 
> Carla Anderson <carla_rayne at yahoo.com> wrote:
>   Jeff,
> 
> You are coming across as patronizing. I am sure you
> dont mean to. We all have been saying for a long
> time that it is obvious that the real core of the
> issue is not the care NPs and PAs give, it is about
> the money. You are preaching to the choir about the
> doctors complaints ringing hollow. We know they
> cannot say what they are really feeling. But I
> disagree, I do not think it can be simplified down
> to big business stealing the golden goose. That is
> for one thing selling us short that we can be bought
> so easily. First of all, everyone is some sense is a
> commodity. It is a matter of choice where you want
> to be a commodity and if it is a good fit. We as NPs
> and PAs make personal choices, whether it be to work
> in our own practice, starting at poverty levels to
> try and be our own boss and deliver care the way we
> have always wanted to, or whether we want to work in
> a physicians office, or whether we want to go work
> in a drug store. Who cares? We are not being stolen
> away. We
> are choosing. The hardest part for us is making a
> choice based on information given to us that may not
> be honestly portrayed, even with the best question
> asking, that is why a written contract should be in
> place, and regarding the drug store jobs, reading
> Tracy's article AGAIN would be very helpful to
> assist our choice at least not being a surprise. I
> do think it is about money, but I think it is also
> about patient choice, and the physicians are mad
> simply because patients have more choice, in other
> words we are back to the concept of more
> competition, and yes it is childish, and the higher
> road would be to be happy that there is an
> alternative for patients if the provider is truly in
> medicine for altruistic reasons, but no, so much is
> about money, and this is potentially hitting pockets
> in a big big way. If the retail clinics did not
> exist, those patients with the ear infections, and
> bladder infections and rashes would have to pick up
> the phone and go to their doctors
> office, and maybe wait a few days, and now those
> doctors are losing that segment of the population.
> And yes it is being rubbed in their faces because
> there are commercials, and ads in AARP, and in the
> many newspapers, but it is not so much who is giving
> the care, it could be all docs working in those
> clinics. So lets take your commodity on the shelf
> analogy, instead of US being offered on another
> shelf at a cheaper price, I say the issue is that
> patients just have MORE ITEMS on the shelf to choose
> from, and they dont care what big or small
> businesses put them there, just that they have more
> choice. So it is about supply and demand, but the
> supply is not the NPs, it is the access to care, and
> points of care. Just like now there is a clinic in
> an airport, with doctors as investors. I am sure if
> the airports all started popping up clinics with
> doctors staffing them, the docs in the regular
> offices would be upset about that too, because it
> would be taking away their
> potential business...and those clinics might be
> privately owned, not by big business, and might be
> physician staffed, so again the issue is not the NP
> or PA or big business but the decrease in demand for
> their services, just like the housing market. The
> answer is for these docs is either start their own,
> or make their own existing practice more like what
> is attractive about the retail clinics- open more
> hours, lower prices, no waiting for appt dates,
> close locations to pharmacies, or quick faxing or
> call ins. Of course that would be a great
> improvement, as rising to the highest level would be
> good for healthcare, but they still cannot replace
> or ever become what a Nurse Practitioner offers,
> that unique blend of nursing and medical provider
> care. That is my opinion, Carla/Oregon.
> 
> Jeffrey Hazzard wrote:
> Tracy,
> 
> No, I think that is EXACTLY the point. The doctors
> don't have any objection until the money for our
> labor is taken out of their pockets and put in the
> pockets of big business. Big business has found an
> innovative way to cut the doctors out and they are
> ticked off about it. They can't fight back in any
> manner except to cast doubt about us. 
> 
> Think of us as a commodity if it will help you.
> Imagine that we are a product on the shelf in the
> doctors' offices that only they are allowed to sell.
> Now imagine that another business puts the same
> product on its shelf at a cheaper price. Our
> situation is similar, and it is as if the doctors
> are saying the product which they promoted when they
> owned it is now second-rate and not to be trusted.
> 
> The point I've made is NOT that we are setting up
> independent practices. The point is that we are
> functioning in a dependent employee situation
> analogous to the ones we held in a doctor's office.
> The point I've made is that the docs' complaints
> ring hollow because they are only making the
> complaints when we are no longer profitable to them;
> our profits are now going to big corporations.
> Doctors complain about quality of care because they
> can't say, "We're pissed off because Wal-Mart stole
> our golden gooses."
> 
> The issue has never been the care we provide. It is
> about who makes money from our labors. It is like we
> are this precious profit center now being struggled
> over by a clash of titans. We want the corporates to
> win because it will eventually lead to our autonomy.
> The docs are scared. They are angry. They are losing
> profits AND that profit source is going to compete
> with 
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