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Message	Let’s Stand Up Before It’s Too Late There is a disconnect that hurts NPs and PAs when it comes to healthcare reform and our future in it. The premise believed by many who determine healthcare needs and staffing is that there is “doctor work” and then there is the work that the “other” professionals do. Many administrators, health planners, politicians and insurance company decision makers still believe that no other professions really do what physicians do. In some cases, it’s true. Not too many NPs and PAs are the primary surgeon in an open heart case, nor are we inserting many new hips. But in most cases, it’s not true at all. There really is no longer “doctor only” work. The perception especially hurts in primary care, where good experienced PAs and NPs have spent years proving they can provide most, if not all of the general medical services any community would need. In this regard, our professional names also add to the confusion because to the uninformed, “assistants” and nurses” are not expected to practice at the level that a physician practices at. We are just not expected to do the same things. There also is a pretty good disinformation campaign directed at PAs and NPs from some parts of organized medicine who regularly appear on the news and usually say that “NP and PAs are OK but they don’t have the training to know when something is strep throat or meningitis or possibly can’t tell the difference between a simple rash and skin cancer”. “Wait a second” says the public and some of those decision makers, this makes all the sense in the world. If they could tell the difference, they would be physicians, wouldn’t they? Little do they know. Pushing healthcare reform out of the picture for a moment or two, the other important issue facing us is that there are not enough people around delivering primary care. Even with over one hundred thousand of us practicing primary care for years (along with MDs and DOs), our country is not close to being able to provide the primary care services our country needs. Now here’s where the disconnect comes in. If physicians are the ONLY people expected to provide these “doctor services” and there are not enough of them to do it, there is only one way to solve the problem; let’s go get some more doctors. There are two ways to get more physicians, and either one would not be the best thing for our country. One would be to build more medical schools and double the size of enrollment in all of them. This sounds good to the uninformed but would still not guarantee that a higher percentage would practice in primary care. So we would train more high priced specialists.The other (and the one which organized medicine has a bit more control over) is to reach out to 10 selected countries and bring in 100,000 of their physicians to provide only primary care. We could give them 10 year visas and maybe even tell the public we are “upgrading” their training. They would enter ONLY primary care residencies and maybe be given a provisional license where they would need loose collaboration or supervision. They easily could begin treating people within a few years. This “foreign trained” physician option is being suggested by some physician groups much more frequently of late. We know they won’t suggest training more PAs and NPs that’s for sure!. The unfortunate problem is this would be a horrible decision for many reasons, as we have NPs and PAs who clearly have demonstrated they are ready to take this on and please let’s not forget the ethics involved in taking 100,000 physicians away from countries that need their physicians even more than we do. That being said we have taken in physicians from around the world many times before to cover up our healthcare manpower mistakes. So where do we go from here and how do we STAND UP before it’s too late? That’s coming soon. Dave http://www.clinician1.com//blog/view/lets_stand_up_before_its_too_late

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