Wednesday, February 20, 2013

Sticking it to the American Medical Association

I don't like the American Medical Association. I don't like them because they've spent most of the past 20 or 30 years lobbying state medical licensing boards to restrict the number and size of medical schools due to a supposed over-supply of doctors (which was controversial in the first place). Moreover, they've also worked to significantly limit the number of foreign doctors who can come practice in the U.S. With a restricted supply of physicians, doctors have higher salaries, thus we pay more for medical care. Worse yet, most of the already limited supply of physicians coming out of medical schools, for a variety of reasons, want nothing to do with primary care, which is arguably the most important form of health care. So what can we do about this? Matt Yglesias presents a  possible solution--nurse practitioners:
"In 18 states (disproportionately but not exclusively rural ones) and the District of Columbia, a nurse practitioner can examine, diagnose, and treat patients in a primary care context. Nurse practitioners also get paid less than doctors. Medicare reimburses them at 85 percent of the doctors' rate, for example, but they also charge less to insurance companies and out-of-pocket patients. And since the "blue states" in this sense are a pretty diverse lot, we can get pretty good quasi-experimental data as to whether cheaper nurse practitioners are actually any worse than primary care doctors in this regard. The answer is a resounding no."
Here's a map of where NPs can and cannot practice independently, by the way.

Granted, nurse practitioners aren't able to replace specialist doctors, but since newer physicians are heavily skewed away from being primary care doctors in the first place (and have been for about a decade), allowing more nurse practitioners to step in seems only too logical. This is especially true given the scope of our primary care shortage and the fact that it takes a lot less time to train new nurse practitioners than it does to train new doctors. The Affordable Care Act sought to remedy this shortage by raising primary care physician payment rates under Medicare and Medicaid, but that's a modest and insufficient solution to such a daunting problem.