Deseret News | It's not always necessary to have a doctor in the house

Reader comments
Marjorie Cortez: It's not always necessary to have a doctor in the house

DrMac | 3:51 a.m. July 14, 2009

How sad that this writer's bias obviously keeps her from the truth. Medicare & Medicaid restrict physician choice of diagnostic & treatment procedures. Private insurance in many cases is more restrictive. The mature woman speaks from experience. Obama's program is the WRONG approach!

medicare | 7:07 a.m. July 14, 2009

You might think that Medicare is socialistic but I don't. I worked for over 30 years and paid in for the older generation (my parents and grandparents who deserved it, and I have no qualms about accepting it now since it was taken from my paycheck. I hardly think that is socialistic.

Obam's approach is wrong. While many nurse practitioners are fine, I am one of these that would rather see a doctor too who still has more experience than they do in a more critical situation.

Costs could be cut if the parents wouldn't take the kids to emergency for every little thing but to their pediatrician.

We try to go to our regular PC doctor if we are ill before we go to Emergency. Most times they can run the same tests and prescribe the same or better antibiotics than the ER and it's a lot cheaper for keeping health costs down.

wallofvoodoo | 10:22 a.m. July 14, 2009

People criticize the possible problems with socalized medicine when the provate insurance model we have now has the exact same problems.

I think people should be able to choose between a DR. & a PR or Nurse Practitioner, but they should have to pey the extra cost themselves if they make that choice to see a Dr. when it isn't nescessary. Maybe people should have to get a referral from a PA to see a Dr. I think PA's are an underutilized resource in medicine. Another part of the problem is that it costs just as much to see a PA as a Dr. so why settle. If they said a Dr. co-pay is $25 & a PA copay is $20, I bet more people would want to see a PA.

Comments continue below

oh_please | 10:26 a.m. July 14, 2009

"What's worse, seeing a physician assistant who has much of the same training as a physician"

This is about as false of a claim as can possibly be made. Not to knock PA's or NP's but two years of school followed by maybe a year of post grad is not comparable to 4 yrs of a doctoral medicine program with over two years of diagnosis/clinical training, followed by 4-8yrs+ of post graduate 80hrs-a-week training. The diagnosis of disease is subtle and requires much experience.

PAs make an enormous contribution to patient care but medicine should always be prescribed/practiced under the supervision of a licensed physician. There training is not at all comparable.

PA v. MD Training | 11:10 a.m. July 14, 2009

PA’s go through a 2 year medical school, including 1 year of classroom and 1 year of clinicals. Then they begin practicing medicine under the supervision of a Doctor. After 5 years of practice, they have a total of 6 years of supervised clinical experience and 1 year of classroom.

A doctor goes through a 4 year medical school which is 2 years of classroom and 2 years of clinicals. Then the MD enters a 4 year residency program which is supervised clinical practice.

What is the difference between an MD and a PA? After a PA has practiced for 5 years, the difference boils down to the fact that the MD has studied the rare diseases for a year that the PA has not. The basic sciences, pharmacology, Anatomy and Physiology classes etc, are often taught to mixed MD/PA students in the same classes.

Retail Based Clinics | 11:14 a.m. July 14, 2009

I am glad to see Ms Cortez recognizing the advantages of Retail Based Clinics such as the ExpressCare's. As a Health Policy Reasearcher for many years, these in-store clinics have lowered costs of medicine greatly and have passed those savings on to the patients.

They save costs by:

1. They pay low retail lease rates instead of high professional medical office lease rates.

2. They utilize Phyician Assistants instead of paying high MD salary's.

3. They are paid at the time of service. They do not waste money on billers who have to fight with insurance companies, etc. With no accounts receivable they are very efficient operations.

Hopefully, congress will take notice.

PA's like medicine | 11:19 a.m. July 14, 2009

Because to get into a Physician Assistant Program, which is almost always a Masters level program, a PA has to have a BS just like an MD. The big difference is that the PA must also have 2 years of licensed patient contact experience. A PA has experienced medicine, and likes it, and wants to expand his/her service to patients.

An MD has no clue if he even likes medicine until he finally gets some patient contact in his 3rd year of medical school. By then, he has too much invested to change his mind. The career satisfaction of MD's is much lower than PA's.

PA is more of an apprenticeship to medicine for bright students who like medicine. That probably contributes to the fact that PA's often have higher patient satisfaction than MD's.

oh_please | 11:57 a.m. July 14, 2009

Practicing under the supervision of a doctor is not the same as a residency program and anyohe who says otherwise in either lying or naive. And believe me there are many MDs who have had much hospital experience before they go to medical school. To the idea that most MDs do not love what they do is ill-informed. To suffer through med school 6 years of residency (thats 8 years of 80 hour per week days making nothing) and then run a practice with too many patients, not enough time, and dismal reimbursements the only way you could stay sane is to love it. I work with hundreds of PAs over the years and I know of few who would support the claim that their training compares at all to the time and depth of a licensed physician. The true test is what makes for better pt care. Sure some training can spot a fever but it takes much more to tell a common cold from more deadly kawasaki disease or when a simple cough requires emergent surgery.

@ Oh Please | 12:42 p.m. July 14, 2009

Your comment that "The true test is what makes for better pt care." has actually been studied. The result? Comparable outcomes for patients treated by both non-physician providers and physician providers in primary care.

Bottom line? Why pay an automotive engineer to change your tire when the mechanic does just as well.

Save MD's for the refractory / rare cases. Don't pay inflated prices for primary care that can be treated just as well by non-physician providers.

experienced_mom | 1:14 p.m. July 14, 2009

I have to say I agree with oh_please. But I need to dispell some misinformation about billing. When you see a PA and a doctors office the reimbursement rate is the same as when you see one at a clinic, or a "express" shop. There is no extra amount paid when you see one in a regular office. So the idea that you play "inflated" prices. (Those express shops and clinics still must have a licensed physician associated with them so they still have to pay for a doctor). Moreover, when you see a PA in a MD office if you have something that requires and MD they are right their and can see you in that appt and they get NO extra billing for it saving you time and money (off work) instead of a clinic whose MD is offsite and must refer you (and thus you a billed again) taking extra time out of your day.

Referral Rates | 2:11 p.m. July 14, 2009

Primary care has approximately a 20% referral rate, whether it is by MD's or PA's. That means that both can see 80% of what comes in the door.

If you are referred by either a PA or an MD, then there will be an additional fee for the specialist regardless.

Additionally, in group practices, it is common for a PA to be pulled in by an MD for a consult on something the PA is more experienced with than the MD.

experienced behind the scene | 2:28 p.m. July 14, 2009

PA's offer many wonderful services, I' m not sure how well those who go to see PAs understand that, although PAs understand some about medicine, there are many nuances they don't understand, and thus they contact the Doctor behind the scenes to make sure they are going about the right way and providing the right care. My husband works in a clinic where they have an after hour urgent care system where much of the time it is staffed by PAs. The on call doctor then gets calls from the PA on more difficult and complicated cases (which are more common than you think)There is no different charge whether you see the PA or the Doctor. What is charged to insurance companies is what type of visit it was, such as what actually happened in the visit. The difference comes in how much the PA and the DR get paid. The Doctor does a whole lot more service than just the time you see them in the office visit. They are "on call" for much of their time away from the office and are dedicated to helping people in more ways than I can list here.

Currently medicaid and medicare | 2:51 p.m. July 14, 2009

& TRICARE (the governments health care for the military) do not even reimburse the primary care physicians enough to cover the cost of running the office so they can be seen. According to the Medical Economics Journal, fewer and fewer physicians are able to accept Medicare patients at the threat of going bankrupt.I was on TRICARE and had a hard time finding anyone who would except my insurance outside the government run facilities.The problem with Obama's proposed system is that you can't get something for nothing. The money has to come from somewhere, and that somewhere is going to be from your pocket, AND the government can simply say you can't have it done. The way the current system is, yes you have to pay for it, but you have a choice of when you want it done. If you want surgery done within the week you can get it, as opposed to the Canadian system where you have to wait in line for a long time just to discover what is wrong, and then wait to get something fixed. All politicians making laws about the economy and restricting good & services need an economicsclass

the truth | 5:23 p.m. July 14, 2009

Unfortunately,

While you give CONTROL and POWER and DECISION MAKING, and the PURSE STRINGS,

to government or insurance companies,

you will NEVER have the choice.

Dave Mittman, PA | 9:52 p.m. July 14, 2009

Let's all calm down. I am a PA for 35 years and have met many a skilled and wonderful nurse practitioners and PAs. My family sees many. I have also met and worked with many skilled and wonderful physicians. All of us who care and stay up on their education are great. Those physicians who work with us don't mind being questioned or second guessed, and neither do the NPs or PAs that work with them. That's the best way to practice.
The nation needs us all. It's not an all or none end game.
Dave Mittman, PA

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