How Should Doctors Spend Their Time?
Breaking: We have a healthcare crisis in this country. Costs are exploding even as a number of key health indictors remain flat or in decline. Several innovative solutions have been proposed to stave off a budgetary crisis, including the recently rolled out Affordable Care Act. And pilot programs continue to seek out new ways to manage imaging, diagnostics, prevention and procedures.
But are we missing some deceptively simple steps to improve American medicine?
This recent piece in the New Yorker touches upon a growing sense that doctors are being stretched too thin on tasks which could easily be delegated to nurse practitioners or other professionals. The article’s author, Celina Gounder of New York’s Spencer Cox Center for Health, points out that she spends most of her time with each patient running tests on blood pressure, pulse, weight and so on:
Does all this require someone with my training: sixteen years, including medical school? Absolutely not. A medical assistant, who can be trained in as little as a year, or a registered nurse could provide all of these services. And if they did, I would have more time to focus on more complicated problems and patients like Carl, with his seizures. . . .
[N]urse practitioners and physician assistants are well-equipped to do that kind of protocol-driven work, and allowing them to take it on would give doctors more time for the medical sleuthing that only we can do, and that many of us happen to love.
The barriers to reforming this system, and to improving our guidelines on who can do what, are formidable. But they represent yet another inefficiency which hampers our ability to provide consistent care even at peak volume. And as more and more patients enter the system in the coming months, primary care physicians will need all the help they can get.