It constantly amazes me what happens when doctors become politicians. They instantly forget how to be good doctors and cease to be effective problem solvers. They become compromisers or worse, magical thinkers who promote solutions like Obamacare that sound good on paper but actually make things worse.
U.S. Doctor Shortage
There is clearly a doctor shortage in the U.S. Apparently, a physician-turned-politician named Keith Frederick decided to solve the doctor shortage problem while paying no attention to the root cause. Fredrick, an orthopedic surgeon and state representative in Missouri, sponsored a bill that became law in Missouri called a “first–of–its–kind solution to the physician shortage plaguing thousands of U.S. communities.”
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Early Licensing Law For Doctors
Frederick’s law licenses a brand, spanking-new graduate of medical school to go out and practice medicine on people without “working through years of traditional residency” ... what you and I call "training." The inference is that all those pesky, expensive years of postgraduate training are not truly necessary to practice good medicine.
Anyone who is an experienced physician knows that when you graduate medical school, you have lots of theoretical book learning but are not yet competent to give high quality or even safe care. You have no judgment. You don’t know how to practice medicine yet. You only know how to think about medical problems and answer test questions.
I write with all candor that I would have been dangerous to patients if I had started treating them the day after I got my medical degree. Any physician who is honestly self reflective would say the same.
Untrained Doctors Are Not Nurse Practitioners
Frederick’s law seems willing to recognize the deficiency in practical experience by licensing these untrained graduates to provide “only primary care services in ‘medically underserved’ areas as long as they are supervised by another physician.”
There is a name for care providers who practice medicine while strictly supervised by physicians. They are called nurse practitioners.
These are nurses who are trained to practice basic triage and error-free medical care. They are not weighed down with all that theory and history that doctors must learn. Nurse practitioners provide an invaluable service. They know what they know and more importantly, they know what they don’t. Nurse practitioners understand their limits.
Untrained physicians are not like nurse practitioners. The former are likely to make mistakes through inexperience, mistakes that nurse practitioners are trained to avoid. Patients know the difference between a nurse practitioner and a doctor. They adjust their expectations accordingly.
Caring For The Medically Underserved
More worrisome is the limitation of early licensees to “medically underserved” areas. Patients who live without readily accessible medical services typically have not had routine or preventative care. They are sicker and more complex than others. They require the highest level of experience and finest judgment, not the lowest and least.
Jeff Howell, government relation’s director for the Missouri State Medical Association, spoke glowingly about early licensing, saying, “It kind of allows us to be a trailblazer on the issue.”
Missouri may be blazing a trail but it leads to medical malpractice court.
Given the number of avoidable adverse effects that are likely to happen to patients because of care given by untrained, inexperienced providers, the early licensing laws in Missouri, Arkansas, and Kansas might be a Christmas present to medical negligence lawyers.
The Contagion Is Spreading
Early medical licensing law was passed in Missouri almost two years ago. Why talk about it now? Because the lunacy is growing, the contagion is spreading. Last year, Arkansas and Kansas passed similar laws. Currently, Oklahoma is considering joining the Midwest march of lemmings.
Two years after passage of early licensing, state legislators in Missouri still cannot make it work. Issues remain unresolved regarding eligibility, credentialing, indemnification, qualifications, regulatory compliance, even the license itself.
For the record, not a single individual has taken advantage of early licensing. One wonders if new medical graduates have more sense than gray-haired physicians–turned–politicians.
Government Needs to Get Out Of Healthcare
There is a valuable lesson to be learned. We The People are experiencing the fiasco Democrats call healthcare reform, Obamacare. Insurance costs are up. New, hidden taxes are pulling ever more dollars from our wallets. The insurance plans or doctors that “you like” – you can’t keep them.
Sadly, bureaucratic insanity is not limited to Washington. State government too is capable of passing “fixes-that-fail-or-backfire,” as the Missouri early licensing law proves.
Centrally controlled, government solutions for healthcare don’t solve healthcare problems. Only decentralized, consumer empowered solutions will work in American healthcare.
Dr. Deane Waldman MD MBA is author of just released “The Cancer in the American Healthcare System;” Host of www.wecanfixhealthcare.info; Professor Emeritus of Pediatrics, Pathology and Decision Science; and Adjunct Scholar (Healthcare) for the Rio Grande Foundation, a public policy think tank. Dr. Deane sits on the Board of Directors of the New Mexico Health Insurance Exchange as Consumer Advocate. Opinions expressed here are solely his and do not necessarily reflect the opinions of the Board.
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