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

Chrissy wrote:

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

PkrBum wrote:"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

Bob wrote:

Chrissy wrote:

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

Of course I'm not. There is no such thing as a PA without backup of a doctor.
If there was no backup of a doctor it would be called an "A" instead of a "PA".
lol

Bob wrote:Actually it wouldn't even be called an "A" because it wouldn't be "assisting" anything. We'd have to come up with a new letter for it.
Maybe an "AWAAN" (an Assistant Who Aint Assisting Nobody). lol

Chrissy wrote:

Just call them doctor

Chrissy wrote: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

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.

2seaoat wrote: 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.

Bob wrote: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.

Bob wrote: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.

Slicef18 wrote:

Bob wrote: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.

Also typical of the Nurse Practitioner.

Chrissy wrote: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.

Slicef18 wrote:

Chrissy wrote: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.

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

That has already been done to the nursing profession. There was a time when nurses graduated from hospital based programs where their training was three years of continuous education. They didn't get summers off. There is no comparison between a three year hospital based nurse and other programs. Ask most any physician and he'll tell you he'd rather have a three year hospital based graduate over any other type nurse.

Chrissy wrote:

Slicef18 wrote:

Bob wrote: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.

Also typical of the Nurse Practitioner.

This is true. Ive seen, been treated and work with both NP'sand PA's. They are/will be no different when they open a private practice. They are not now, it must be a perception thing, other than you can get lucky.

Im really appalled at the easy acceptance of people being so willing to downgrade the educationl and training requirments for our doctors.

Who knew this group of people thought doctors were over educated and trained. hmmm

Slicef18 wrote:

Chrissy wrote:

Slicef18 wrote:

Bob wrote: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.

Also typical of the Nurse Practitioner.

This is true. Ive seen, been treated and work with both NP'sand PA's. They are/will be no different when they open a private practice. They are not now, it must be a perception thing, other than you can get lucky.

Im really appalled at the easy acceptance of people being so willing to downgrade the educationl and training requirments for our doctors.

Who knew this group of people thought doctors were over educated and trained. hmmm

NP's and PA's must work under the care of an MD physician. They cannot put out their own shingle.

Chrissy wrote:

Thats my point. You may want to re-read the article. They will be getting thier own practices and own shingle with this.

Slicef18 wrote:

NP's and PA's must work under the care of an MD physician. They cannot put out their own shingle.

PBulldog2 wrote:

Slicef18 wrote:

NP's and PA's must work under the care of an MD physician. They cannot put out their own shingle.

NPs can establish their own practices in several states, Slice. I don't know which states permit NPs to do so, but I do know Florida is not one of them.

Here's an article that addresses this:
http://nurse-practitioners-and-physician-assistants.advanceweb.com/features/articles/establishing-an-independent-nurse-practitioner-practice.aspx

One fact I have not seen anyone address as yet is that NPs will probably need to have a doctorate in nursing in the future to begin practicing as an NP under any circumstances. I'll see if I can find an article about this later.

I don't know of any plans to permit PAs to establish independent practices. Their very designation - physician's assistant - seems to contradict that potentiality.

Dreamsglore wrote:I've never heard of a doctorate in nursing. I thought nurse practitioner was the highest you could achieve.

Sage wrote: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