Physicians Assistants, Nurses, Practitioners : New Roles?

This is not new - I have first hand experience with this and it happened more then 10 years ago. I needed to see a doctor, called for an appointment and then arrived on the appointed date and time only to find that instead of seeing the doctor I was interviewed by a 'phisicans assistant'.

Okay, not the end of the world but I was not sure he knew what he was talking about concerning my problem, and why should I be, he was an assistant, not a doctor. My confidence level was low to say the least, he might have known what the problems and the cause as well as the cure, but it was not his training or experience that worried me, of course I had no idea what his training was or how much experience he had related to my problem, it was the fact that he was not a licensed doctor uneasy.

The reason you go to the clinic for a problem is to get some sort of assurance that the person you are talking to about your problem knows more then anyone else in the clinic, this is what you are paying for, not the doctors aid or assistant. It's the confidence level you get from knowing you are talking to a 10 year trained physician that makes the difference between 'this is the problem and this is the cure' or 'I think this is the problem and I think this is the cure'.

Also, be alert, I was charged the same price for seeing the physicians assistant as seeing the doctor. Believe me that was not easy finding that out, and there was no refund. No amount of waving of the arms did any good.

If California and other states decide to take the path of nurses and assistants doing the ground work for the doctors is all well and fine, but then they have to charge less and then defer the final assessment to the doctor at a later date. This would actual reduce the cost, in some ways, of health care, in that many of the problems that people come the clinic for are routine and can be handled by lesser individuals, costing the state or insurance companies less. Maybe, but don't hold your breath.

States Seek to Redefine Who Can Provide Care
February 14, 2013
Source: Michael Mishak, "State Lacks Doctors to Meet Demand of National Health Care Law," Los Angeles Times, February 9, 2013.

As states expand health care coverage as mandated by the Affordable Care Act (ACA), they are likely to experience a shortage of doctors in attempts to treat an influx of newly insured patients. States are taking various measures to solve this problem, says the Los Angeles Times.
Take California, where state Senator Ed Hernandez says there will not be enough doctors to treat new patients.

• Sen. Hernandez has made proposals that seek to redefine who can provide coverage.
• The new proposal would allow physician assistants to treat more patients, nurse practitioners to set up independent practices and pharmacists, and optometrists to act as primary care providers.
• Hernandez's proposed changes would shake up the medical establishment in California and could affect the success of the ACA in California.

The National Conference of State Legislatures says that since January 1, more than 50 proposals have been launched in 24 states that alter what health professionals are licensed to do. The new proposals join the more than 350 laws that have already been enacted in the last two years.

• Just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with more than 30 percent of the state's doctors nearing retirement.
• It takes more than a decade to train a physician and the pace of expected graduates will not keep up with the expansion in patients needing care.
• Doctors say physician assistants and other midlevel professionals are best deployed in doctor-led teams and that allowing these health workers to set up independent agencies would create voids in the clinics, hospitals and offices that they currently work in.

Whether or not these midlevel professionals are granted new responsibilities that are within their training, the fundamental problem of not having enough doctors to treat the growing number of patients in the U.S. health care system still exists.