The Nurse Will See You Now

Written by David Sprayberry M.D.

Something has got to change.

In recent years, the practice of medicine has been under attack from a variety of sources. Insurance companies continue to squeeze both physicians and patients in order to increase their already enormous profits. Our federal and state governments have decided to target physicians when an error is made in the exceedingly complex billing process in order to levy fines and recoup some of what they spend on Medicare and Medicaid.

Our federal government purposes to replace physicians with cheaper, lesser trained individuals who have not received nearly the level of education that physicians have. Even other healthcare professionals who have traditionally been a part of the physician’s team are seeking to take on the role of a physician and become your “provider.”

I fear that the best and brightest students will increasingly choose careers other than medicine if we as a nation continue to demean the work that physicians do and continue to attack the physicians who entered the field with altruistic intentions. It is also quite possible that the U.S. will lose practicing physicians to other nations that value their services more highly or at least do not make it as painful to do their jobs.

The American public needs to spend some time thinking about what they want from our medical system. Do they want their primary physician to be merely a coordinator of care or do they want him or her to be the provider of care? Do they want nearly all their office visits to be performed by a nurse who only calls in the physician if something is complicated or do they want a physician who is capable of detecting serious problems based on subtle findings or symptoms? Do they want to see a nurse when they go to a specialist? Do they want the person who is deciding whether they may have cancer to be someone who has never spent sleepless hours at the bedside of someone dying of cancer? Do they want the person who is deciding whether their child should be admitted to the hospital to be someone who has never seen a patient progress from simple wheezing to respiratory failure and death in a matter of hours? Do they want the person counseling them on whether to get that new vaccine to be someone who has never taken care of a child who died from a vaccine-preventable disease?

Our current system continues to march toward having nurses provide medical care and physicians only supervising and taking care of “complicated things”. Is this really what we want?

Dr. Sprayberry is a practicing pediatrician in Watkinsville, GA and blogs at Pediatrics Gone to the Dawgs

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3 thoughts on “The Nurse Will See You Now

  1. Nice Post Dr Sprayberry! Your point on the next generation of potential physicians is exactly the reason we have been focusing on the process of new business model creation for primary care docs. Without creation of new practice solutions that are customer centric, validated by market pricing rather than artificial pricing of medicaid and medicare, we will lose our next generation. Read Clay Christensen’s innovator’s Prescription and you can see how it will play out according to one of Harvard’s Top Dogs. Ecommerce and membership models may be a viable addition/ alternative to third party payer practice. Clay calls them Member value networks for health. There are 8 or so other business models as you and I know, many of which do NOT INVOLVE PHYSICIANS at ALL. We must innovate and create value or the NP’s and PA’s will truly be the physicians of the future.

  2. I’m at a loss for words after reading this. I am a NP in a pediatric practice with a solo pediatrician. I have been an NP for 10 years and yes, I have taken care of children with vaccine preventable diseases, I have spent sleepless hours taking care of someone dying of cancer and I have seen children progress from wheezing to respiratory failure. There is room in the world for all of us. I wish more physicians would realize that NPs are not a threat to them.
    Laura Baker, NP

  3. Laura,

    I apologize if my post offended you, that was certainly not my intent. I think NPs can be an extremely effective part of the medical team, and I have both learned under NPs and supervised NPs. I had the pleasure of learning from a fantastic NP who ran an indigent care clinic where I went to med school. The NP I supervised was very capable and reliable and she was quite valuable to my practice. I have nothing against NPs and my post was not directed toward NPs, but toward the American public.

    The gist of my post is that many in our nation, particularly in our government and in our insurance industry, would indeed like to have NPs and PAs serve as THE primary providers of care, with physicians serving primarily in a supervisory role or in the role of a subspecialist (who may also be supervising NPs and PAs). Most physicians did not enter the profession with the goal of being a supervisor. We would like to take care of patients.

    You clearly have a broad range of experiences in your career and you are to be commended for that. I did not intend to belittle your experience or your expertise, but I did intend to point out that the training that a physician receives is quite different than the training that an NP or PA must complete to begin practice. The American public does need to decide what they want. If the answer is that they want to see an NP as their provider of primary care, then so be it. The consequence, though, is that our nation’s top students will either not choose medicine as a career, will not choose primary care, or they will practice outside the U.S.

    I hope that clarifies my post a bit and my apologies if I offended you. Good luck to you in your career.

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