California re-defines who is a doctor to keep up with obamacare doc shortages

As a result of Obamacare and its expansion of coverage to millions, many states will begin to experience doctor shortages. California is dealing with this problem by redefining who is a “doctor.”

State lawmakers are working on legislation that would permit physician assistants and nurse practitioners to set up independent practices. Pharmacists and optometrists could now act as “primary care” providers.

These role changes will be common in the age of Obamacare, when even teachers will be “trained” to diagnose mental health and behavioral health problems in “school-based healthcare centers.”

As State Senator Ed Hernandez (D) says, “What good is it if they are going to have a health insurance card but no access to doctors?”

The solution, to those who support ObamaCare, is to permit more people to do what “doctors” have done in the past.
http://www.breitbart.com/Big-Government/2013/02/12/ObamaCare-Doctor-Shortage-No-Problem-Just-Redefine-Doctor

Hate to say I told you so. But I am saying I told you so.

We'll just lower our standard so we can meet these demands.

good luck

I bet doctors start leaving california, and nurses and PA's start running to california.

We'll just lower our standard so we can meet these demands.

My niece is a well trained PA. She has worked in two states with different regulations. In one state she was given a great deal of latitude. In another state she was far more restricted in her practice. The key to understand the role of a PA is they are under a doctor's supervision. With as much of my time at doctors in various fields of specialty, I can tell you that I spend most of my time with the doctor's PA and find them often more knowledgeable than the doctor. I have been misdiagnosed at least four times by some of the best doctors in the country. Everybody is capable of error, and the key to an expanded utilization of PAs is expansion of software which objectively captures a patients symptoms and improved medical records so that PAs can package visits with patients for efficient review by doctors where a person raises a red flag.

These protocols should be in use with doctors, but it invades their sense of being something more than a computer program. I think Ca is on the path to a model which could revolutionize health care. If every Walgreens or Walmart had a PA 24/7, America could relieve our emergency rooms and finally provide a framework of primary care which actually can prevent advancements of disease by affordable early detection. To assume that this system of using PAs is going to lead to a decline in care is a mistake.

eye doctor---wth are they talking about , If im really really sick thats the last place I would want to end up, an eye doctor nope not me!

eye doctor---wth are they talking about , If im really really sick thats the last place I would want to end up, an eye doctor Razz nope not me!


Try going to a doctor for a year complaining of breathing problems and not once was a proper breathing test ordered, or even a simple xray. I left and went to another doctor after the first insisted that I had asthma.......without discovering the tumor which held both sides of my left lung lobe together......my daughter had her Lupus discovered by an eye doctor who suggested that she immediately see a physician because something was not right. No, this idea that initial screenings cannot be improved without having a heavy hitter on the front line is simply wrong. PAs will revolutionize healthcare.

2seaoat wrote:eye doctor---wth are they talking about , If im really really sick thats the last place I would want to end up, an eye doctor Razz nope not me!


Try going to a doctor for a year complaining of breathing problems and not once was a proper breathing test ordered, or even a simple xray. I left and went to another doctor after the first insisted that I had asthma.......without discovering the tumor which held both sides of my left lung lobe together......my daughter had her Lupus discovered by an eye doctor who suggested that she immediately see a physician because something was not right. No, this idea that initial screenings cannot be improved without having a heavy hitter on the front line is simply wrong. PAs will revolutionize healthcare.

Anyone who comes off and says its a good thing that the people treating us have less education, just expect what you get as a whole. PA's are under the direction of a physician for a reason.

Downgrading our expectations of what a doctor is is NOT a good thing.

The complicated cases are going to go unnoticed many times. If you dont think the additional education and internship a doctor goes through is important you are crazy. sorry

If you dont think the additional education and internship a doctor goes through is important you are crazy. sorry


Nobody said that. Rather, it is an allocation of resources which get the job done. 24/7 availability of PAs across America are going to catch serious illness much quicker than this broken system of two weeks to get an appointment, or a trip to the emergency room. Immediate and affordable primary care by PAs is part of the answer. Computerized medical records with portability is the second part of the problem. If we can double or triple the review time of a physician while doubling the number of PAs on the frontline we give greater medical care to America across the board. My niece can do initial screenings probably at 99% efficacy compared to a doctor, and the key is having protocols in place which catch the 1% discrepancy.

I would never suggest that a PA can completely replace the role of a doctor, but with 24/7 medical availability which will now be possible because of the cost savings,......more people will be saved than harmed. Yes, there will be situations where the initial consultation by a PA will miss something that a doctor may have caught, but the key to this gap is proper delivery of medical records and review of the PA by physicians who can handle far greater volume in reviewing rather than hands on time consuming patient direct contact. We need to knock down the union and monopoly before real health care reform can take place.

Dont overlook the contributions of nurse practitioners, Seaoat.

As far as education goes, the NPs of the near future will have to have a doctorate in nursing. That is eight years of education.

Seaoat, my ex-father in law went to his physician with a complaint of persistent headaches. He received pain medication but little else. One day, he had to see the nurse practitioner rather than the physician.

He said the NP took a better history than the physician ever had. She ordered the necessary tests and he was diagnosed with a treatable brain tumor.

He raved about that NP for years - he says she probably saved his life. Prior to that appointment, he said he felt he'd been pushed aside to an NP rather than seeing his physician. He changed his tune after she discovered the brain tumor.

Repeat after me: Less is more... Less is more... Less is more...

My "first contact" with medical care is now no longer an MD. It's now a PA (at Pro Clinic on N 12th Ave).
A Physician Assistant (PA) is defined as: "formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine and treat patients, order and interpret laboratory tests and X rays, make diagnoses and treat minor injuries".
The key to that is "delegated by a physician" and "working as members of a health care team". An MD is part of the team and the PA can consult him/her at any time and will do that.

Why have I made this transition? Well it's because my so-called health insurance does not pay anything toward anything until I reach a $2500 deductible.
I switched to Pro Clinic and the PA because, before I switched, a physician charged me $230 (which all came out of my pocket) for a routine office visit. I switched because Pro Clinic with their "team" gives me a regular office visit with a PA (in consultation with a physician) for $50.

Is there some possibility that my replacing an MD with a PA might lead to an instance where it's not beneficial to my health?
Well I don't know what the research indicates (if indeed there is any), but just common sense tells me, yes, that is a possibility.
But common sense also tells me that it's probably a very slim possibility.
Because Pro Clinic and it's employees (owners, PA's and MD) are just as vulnerable to "medical negligence" claims as an MD is. And they know that.
So for me, it's a tradeoff between that slim possibility and the cost savings.
And if Walmart and Walgreens and Target did what seaoat is suggesting, they too would have the medical negligence tort lawyer industry monitoring them.

The problem with our system of health care delivery can be summed up with one word. The "cost". And there is no solution to the crisis other than to bring down those costs. We've all been made aware repeatedly that our system of health care is more than twice as expensive per capita as any other nation's health care delivery system in the world.

You can point to the escalating cost's to educate a medical doctor is the reason doctors are becoming priced out of the market. But regardless of what the reason is, that doesn't change the fact that they ARE getting to be priced out of the market.

Another example is drugs. I am now buying ALL of my medications totally apart from the so-called insurance drug plan I'm supposedly subsidizing with my premiums. I'm getting them from Walmart and Publix and K-Mart and Canada and paying retail. Why? Because to do that is now less costly for me than what the insurance company drug plan charges me. Even though I'm paying the insurance company to subsidize that price.
There is another single word which can sum up the reason why I'm able to do that and this time that word is "competition".
Walmart and Target and Publix and K-Mart and Canadian pharmacies are all COMPETING and that's what brought the drug cost down.

The same thing could be happening with "first contact" delivery of medical care, exactly as seaoat has suggested. I'm the proof of that because I'm already an early adopter of it by taking advantage of an early adopter enterprise called Pro Clinic.
Except, as seaoat is suggesting, it could be happening in a HUGE way. But it's not.

By the way I should add this. With the MD, I got about five minutes with him. And by that time he was answering questions as he was walking backwards toward the door.
With the PA I get about 15-20 minutes. And I leave the room BEFORE the PA does and he's never done the "back walk" in my presence yet.

Lets clarify something here first of all.

No one is saying PA's are not good. We have 8 where I work. I know what they do and have seen many myself.

We are degrading doctors with this effort. Why even go through the trouble to become a doctor after this downgrade? ]

PA's right now cant not have thier own private practice, they have to work under a doctor. And they have many years less of education and training.

So no one is saying anything negative about PA's. But we are downgrading what it is to be a doctor and tread carefully my friend, tread carefull as we lower our requirments.

Don't get me wrong. I would always prefer to go to a doctor. Hell I liked it even better back when I didn't even have to go to the doctor because he came to me (house calls). lol

BUT that was then and this is now. And the country aint as flush with money as it once was. And regardless of what democrats or republicans either one claim, I don't think we're ever gonna be as flush with money as we once were. SO, we aint gonna be able to keep enjoying the same level of expensive health care we once did.
That's just plain old common horse sense to me.

As a military dependent, we were more often treated by PAs than MDs. What always stood out to me was how eager the PAs were to learn. When one of us had an unusual condition, all the PAs in the clinic wanted to see/hear/feel so that they could make the correct diagnosis if they saw that particular condition again, everything from Fifth Disease to bronchioliotis to GCT of the tendon sheath.

Currently I have a child being treated for a heart murmur that was noticed by a PA. I have a child being treated for Crohn's Disease after his eye doctor diagnosed him with uveitis and referred him to a specialist. I am being treated for COPD that my former family doctor, an MD, blew off as just allergies or maybe bronchitis.

I believe that what is most important is not which letters are in the title, but rather how well a diagnostician listens and observes your symptoms.

I believe that what is most important is not which letters are in the title, but rather how well a diagnostician listens and observes your symptoms.

Bingo! This is the key in any profession. Too often professionals want to put you in their box.......so they talk before they listen. I have learned that the most important skill a doctor has is listening, and then progressing with careful questions, and listening some more.

The data input process must be complete and accurate, and often docs simple do not take the time. I noticed a tertiary treatment and interview process when I went to Moffit cancer center in Tampa. First, a nurse practitioner spent 1/2 hour with me collecting detailed information. Next, an intern working with the doctor spent twenty minutes interviewing me and expanding on the PAs notes. Finally, the specialist in Endocrine cancer....probably top five in the world spent 10 minutes reviewing all the detail collected including scans and notes. It would be incredibly stupid for that doctor to have spent 45 minutes with me to achieve the same level of information for diagnosis. We need to fix this broken system, and PAs are a huge first step, but most important is a standard for medical records which allows easy portability and access by all treating docs and staff.....huge redundancy and cost in the current system.

well, there you have it from the experts. Doctors suck and people who have half the training and education of a doctor are better.

So these people will become the new standard for despensing your heatlhcare.

They will now be able to open thier own private practice without having a doctor be on board.

I bet doctors all over are relieved that they were not really that important after all in your care.

This should start a boom to create PA's and a further decline in people wanting to become doctors. so what.

You dont need to worry that doctors will not be reviewing your charts behind the scenes as they do now. The PA is better than the doctor because thier training is so much better, more rigorous blah blah blah

Good to know this was easy.

who's next?

What profession shall we degrade next? nurses, laboratory personel? perhaps high school diploma will be suficent.

Here's an idea. Lets just down grade all medical personel to the level of mcdonalds workers. flip a burger, you can do insitu hybridization. Change an alternator once, get at that heart valve.

You people really have no idea what you are agreeing to.

If this takes hold and they down grade what it is to be a doctor, you wont know what hit you with the doctor shortages. Not that you care, because you dont. LOL

You seem to think this thread is about defending PA's, it is NOT. It is about defending doctors and the respect they deserve.

Hey maybe if im lucky they will downgrade my profession too and Ill get to be a pathologist. Cant wait.

It is about defending doctors and the respect they deserve.

I do not think one person has disrespected a doctor on this thread. I think there has been unanimous approval of improved methods of providing care for patients which may involve more utilization of PAs.

Let us use a football analogy. It appears that our health care system is like having a team of quarterbacks. QB on the offensive line.....QB on the defensive line.....QB as running backs. A huge payroll and the best QBs money can buy.....but we keep losing the game.

Somebody says.....well what if we get a couple big guys who may not be as talented as the QB but may block and defend better, and put them on the line. Now if we get different talent levels and put them in spots which efficiently optimize the team.....we win football games.

It really is a system wide problem, and it is like arguing that doctors should be typing their billing statements because a clerical person may not code a procedure correctly because they lack the training. This debate is about costs, and efficiently providing the best care to patients at the lowest costs, and as Bob observed in the thread earlier, the US is losing the game right now with our broken model. We need help off the bench, and that means allowing others to do what docs have been doing, but coordinate that effort and maintain quality of care.

Chrissy,

If we're gonna keep having the same number of primary doctors and have the same availability of having access to primary doctors that we've had in the past, who is gonna pay for that? Are you counting on Obama to pay for it with more borrowed money?
Where is that money going to come from? The jobs so many of us have are not as good as we once had. The incomes so many of us have are not as good as they once were? The amount of unemployment is higher than it once was.
So what do you propose we do, go without eating and use the money saved from that?
So many of us can no longer maintain the lifestyles we once were able to have. And that includes having the same level of health care we once had.
And on top of that, we're about to add 30+ million of us to an already strained health care system. 30+ million who cannot foot the whole bill for their health care. Where is that money going to come from to pay for all the EXTRA primary doctors we'll need if we expect to have the same number and availability of primary doctors we've had in the past?
Is Obama somehow going to wave a magic wand and pay for all that?
Because the only magic wands I've ever seen were in the movies.

Bob wrote:Chrissy,

If we're gonna keep having the same number of primary doctors and have the same availability of having access to primary doctors that we've had in the past, who is gonna pay for that? Are you counting on Obama to pay for it with more borrowed money?
Where is that money going to come from? The jobs so many of us have are not as good as we once had. The incomes so many of us have are not as good as they once were? The amount of unemployment is higher than it once was.
So what do you propose we do, go without eating and use the money saved from that?
So many of us can no longer maintain the lifestyles we once were able to have. And that includes having the same level of health care we once had.
And on top of that, we're about to add 30+ million of us to an already strained health care system. 30+ million who cannot foot the whole bill for their health care. Where is that money going to come from to pay for all the EXTRA primary doctors we'll need if we expect to have the same number and availability of primary doctors we've had in the past?
Is Obama somehow going to wave a magic wand and pay for all that?
Because the only magic wands I've ever seen were in the movies.

didnt expect the TAX payers to be able to pay for it. I always knew we couldnt btw.

We have our answer already bob. downgrade the medical profession, lower the standards. Thats why i said I told you so. Because I knew it was coming.

If it starts there it will bleed out into the rest of the country just like every other god damn bad idea from bankrupt california.

I really can not get my head around the fact that everyone here is so giddy about down grading what defines a doctor. I really cant. But I shouldnt be surprised with the crowd Im talking to.

down grading what defines a doctor.

Nobody has suggested that. It is simply an intelligent use of assets to accomplish higher levels of quality. We can walk and chew gum, but the current mess of chaos in medical records, waiting an hour to see a doctor, when that economic cost is multiplied as lost productivity alone the allocation of doctors time instead of PAs is crazy. America is losing trillions by a poorly ran system which is a monopoly which guarantees high paychecks for specialist while primary care is slowly descending to third world status.

Less is more... say it again... Less is more...

There... It FEELS good... say it again... Less for productive citizens at greater cost... More to less productive at smaller/no cost.

Chrissy wrote:
didnt expect the TAX payers to be able to pay for it. I always knew we couldnt btw.

We have our answer already bob. downgrade the medical profession, lower the standards. Thats why i said I told you so. Because I knew it was coming.

If it starts there it will bleed out into the rest of the country just like every other god damn bad idea from bankrupt california.

I really can not get my head around the fact that everyone here is so giddy about down grading what defines a doctor. I really cant. But I shouldnt be surprised with the crowd Im talking to.

Obamacare will make it worse I have no doubt. But there is no obamacare at play in my situation. And it had nothing to do with California.
I just got tired of paying so much for so little time with a doctor. So when the PA solution became available I opted for that.

PkrBum wrote:Less is more... say it again... Less is more...

There... It FEELS good... say it again... Less for productive citizens at greater cost... More to less productive at smaller/no cost.

ok Im workin on it.

Less is more, less is more.

I got it!

Less is more....

Bob wrote:

Chrissy wrote:
didnt expect the TAX payers to be able to pay for it. I always knew we couldnt btw.

We have our answer already bob. downgrade the medical profession, lower the standards. Thats why i said I told you so. Because I knew it was coming.

If it starts there it will bleed out into the rest of the country just like every other god damn bad idea from bankrupt california.

I really can not get my head around the fact that everyone here is so giddy about down grading what defines a doctor. I really cant. But I shouldnt be surprised with the crowd Im talking to.

Obamacare will make it worse I have no doubt. But there is no obamacare at play in my situation. And it had nothing to do with California.
I just got tired of paying so much for so little time with a doctor. So when the PA solution became available I opted for that.

Bob, youre not seeing a PA without the backup of a doctor, its ilegal here and above thier current pay grade.

"Any health care funding plan that is just,equitable, civilized and humane must —must —redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition re-distributional." Obama recess appointment to chief of medicare and medicaid Donald Berwick