The American Medical Association: A Barrier to Longer Healthier Life at Lower Cost!
Blocking the highly beneficial role of nurse practitioners
Our medical system is still designed around the interests of physicians and institutions. It is not patient-centered. In most developed countries, the system is primary care based. Not here. About 35% of our physicians are primary care providers. In other countries, it is flipped. Most doctors are in primary care. This distribution is entirely the result of AMA policy. The committee that determines how the money is split up is secret. There are 27 specialists and 4 primary care doctors on the committee. You can only attend the meeting if the chair invites you. All attendees sign a non-disclosre agreement. The result is entirely predictable and it impacts all payment for physician services. Payment for primary care services have been devalued and as a direct consequence, American primary care is on the ropes.
Now they are coming after nurse practitioners, physician assistants, and they don’t even bother to mention pharmacists. Here is a direct quote from the linked article. “Dressing more people up in white coats and calling them “Doctor” is not an effective way to overcome the nation’s physician shortage….Yet some have argued that nonphysicians such as NPs and PAs—who receive far less clinical training and medical education than doctors, by thousands of hours—can fill the looming gaps in the physician supply without any noticeable drop in the quality of care. However, a mounting body of research and data on the deployment of the health care workforce shows that is simply not the case.”
The AMA’s position on this topic is inconsistent with the facts and it is offensive. It is rank protectionism and a barrier to progress. Here is the truth. Eighty-six percent of healthcare costs in this country are related to chronic diseases. As I have pointed out in the last couple of posts, teams of nurses and pharmacists outperform individual physicians every time when dealing with these conditions. They provide better care for these chronic conditions.
Effective management of chronic diseases like diabetes is most effective when it is systematic. Care teams, protocols, care pathways, case management, care navigation, and systems are more consistent with nursing culture than physician practice. Physicians often dismiss the systematic approach as “cookbook” medicine. Quality is a systems property. Nurse practitioners, pharmacists, and physician assistants can man these teams. Nurse practitioners can lead them. Supporting these teams requires minimal resources and they can offer a great deal in rural and disadvantaged communities. Better care for chronic diseases does not depend on thousands of hours of training. It depends on a systematic approach.
Everyone had a stake in this fight and the evidence is crystal clear. Healthcare system design and financing needs a big dose of sunshine. Our physical and financial health should not be determined by a committee that works in secret to protect its own interests. Nurse practitioner teams for chronic diseases do not mean “dressing up unqualified people in white coats.” They mean better health at lower cost for all of us. Get in the fight! Demand change now! Your rural community or your company can have access to chronic disease management teams today but you can’t leave it to the AMA.
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Absolutely! AMA CPT Code Editorial Panel Kenneth Brin deliberately led an effort, in collusion with the gastroenterologist panelists to stop our proven technology from its rightful place in the mainstream medicine. Thankfully we found our own path to thrive, regardless!
Brilliant insight and exactly our plan at Symbios on Hilton Head Island. See my list of providers!! www.mysymbios.com