Making healthcare more affordable has been a hot talking point during the Democratic primary debates. While Elizabeth Warren and Bernie Sanders have suggested a controversial “Medicare For All” policy which would eliminate healthcare insurance as we know it, other candidates have recommended less extreme public options. Either way, all of the candidates have agreed that our healthcare system is broken. While Democrats and Republicans have proposed different solutions, both sides generally recognize that our healthcare system has flaws. However, I think there is one solution that both sides could rally behind: increasing the independence of non-MD providers.
Part of what limits our healthcare system is its cost. The United States has one of the strongest healthcare systems in the world in terms of innovation, but the cost of healthcare is still high. Although this is an issue, the “Medicare For All” policy would add over $32 trillion to the national budget, and this modest number assumes that healthcare providers would be willing to continue to work in healthcare after suffering a 40 percent decrease in their current salaries. Furthermore, billionaires alone cannot pay for this. An alternative way to make healthcare more affordable is by giving non-MD providers more flexibility and independence. Removing some of the restrictions on patient providers could both increase the supply of providers and lower prices.
A doctor spends six years in medical school followed by a residency and often a fellowship and further training. They sacrifice an enormous amount of time, money, and sleep to pursue a career that will help their community. This investment in providing quality care is admirable, but this prestige comes at a high cost, costs which are eventually passed on to the patient. Many doctors have hundreds of thousands of dollars worth of loans to pay off along with the costs of building a business. They earn their pay; however, the shortage of doctors often leaves them overbooked, especially if they are known to be exceptional providers. This shortage will only grow, and by 2032, it is projected to reach up to 121,900 providers. Basic economics operate on the fact that high demand and low supply lead to high prices. But what if the supply could be raised, especially for more generalized care? That’s where non-MD providers come into play.
When some patients walk into a room and find a Physician Assistant (PA) or a Nurse Practitioner (NP), they immediately demand to see a “real” provider, i.e. an MD. Most patients want to receive good healthcare, and they assume that only an MD is capable of providing the care that they deserve. This stigma against non-MD providers is largely due to patient ignorance of the training that NPs and PAs receive. While most of these providers are not specialized in a particular area upon graduation, they often receive further training and work in a specific discipline for many years. Currently, PAs are required to be supervised by an MD, but NPs are able to open a private practice independently from an MD. Since these providers often work as a team, it might even be overkill to regulate PA practice, especially when they are fully trained and capable of treating non-specialized cases.
Since PAs and NPs spend less time and money on training, they are naturally less expensive providers. The average PA spends $71,000 on their Masters education, but an MD spends well over $200,000. According to a 2017 study, Nurse Practitioners and Physician Assistants provide the same quality of medical care as MDs. And there are already a number of federal and state regulations in place to ensure that PAs and NPs are up-to-date and well-trained in their area of practice in order to maintain their licenses.
Additionally, organizations like the American Academy of Pediatrics (AAP) and the American Medical Association (AMA) monitor state regulations on PAs’ and NPs’ scope of practice. These organizations tend to oppose increasing independence of non-MDs, but the government agencies ought to question these organizations and push for governmental deregulation. The healthcare system is evolving to meet the needs of patients, and these organizations are doing patients a disservice by underestimating the merits of different types of practitioners who are capable of providing competent care.
If NPs and PAs receive more independence in having the option to open their own practices, while still being held accountable to the same caliber of regular certifications, inspections, and qualifications as doctors do, healthcare would be more affordable and accessible. If you have the sniffles and a fever, you most likely don’t need to see a specialist. If you do, a primary care PA could see you first for cheaper, and then refer you to a more specialized physician if necessary. A family practitioner with an MD would likely refer you to a specialist anyways. Why pay more for a provider who went through more schooling and will give you the same diagnosis or referral?
Additionally, after spending several years working with a doctor in a particular specialty, the NP or PA has enough experience to successfully practice independently. Some opponents of NPs and PAs practicing independently fear that the cost of care would go up due to poor treatments and recommendations from the non-MD providers in complex cases. However, many studies have shown the opposite, proving that it would actually reduce the cost of care from between 6-7 percent, which translates to thousands of dollars for many patients.
Although allowing NPs and PAs to become more independent will certainly not solve all of our healthcare system’s problems, it could help in improving cost-effectiveness for patients with common cases. Before we uproot the current system, we should consider other practical options for reducing costs.
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