PookieMD's Blog: Where Physicians Learn About the Business of Medicine

The American College of Physicians, the national organization for Internists, has issued a monograph addressing and encouraging the use of Nurse Practitioners as primary care providers.  The comprehensive monograph encourages Nurse Practitioners to enter the field of primary care, and advocates the use of the “Patient-Centered Medical Home.”  Basically, the idea behind the “home” is that nurse practitioners deliver the care, and there is a physician on the “team” who “collaborates” with the nurse practitioners.  Interestingly, one of ACP’s goals is “to serve the professional needs of the membership, support healthy lives for physicians, and advance internal medicine as a career…”

Gee, if I were a young resident, I would want to spend 4 years in medical school, then 3 more years as a resident to be the supervisor of a bunch of Nurse Practitioners.  (Not!)   Supervising Nurse Practitioners, no matter how skillful or knowledgeable they are, will NOT encourage young physicians to enter primary care.  We become doctors because we want to do MEDICINE, not because we want to supervise those who are actually seeing patients.  Furthermore, who wants the increase in liability that “collaboration” will bring?  You can bet that the physician will be liable for everything the Nurse Practitioners do.  Boy, sounds like a swell deal to me!

No, being the top of the supervisory pyramid is a detractor, not an enticement.  I think this ridiculous monograph will encourage more medical students and residents to become specialists.   The way I see it, most residents pathetic enough to actually be interested in internal medicine will become specialists.  The Nurse Practitioners will deliver primary care, and then refer the complicated patients to the Specialists.  Not exactly an efficient way to deliver care, but maybe this way internists will actually get paid to think, which is what this specialty is all about.

And here I thought the ACP was my advocate?!  Why are they cutting us off at the knees, diluting our specialty and selling our souls?  Why are they not lobbying for internal medicine and primary care to be appropriately reimbursed, and rewarded for thinking, rather than doing?

Why didn’t I do dermatology?