Much medical care is provided by ancillary health care providers.
Perhaps instead of “is there a doctor in the house?” the question should be “is there a medical provider of some kind in the house”?
An internet article on Medpage Today discusses a recent decision by the Veterans Administration to allow some eye surgery procedures to be done by optometrists as well as ophthalmologists. This has resulted in a pushback by ophthalmologists, who argue that only a trained medical doctor should be allowed to do such procedures. Optometrists are not trained medical doctors, but are licensed after a shorter period of training.
Over the past decade or so, states have begun to allow optometrists to perform many such invasive procedures, including laser surgery procedures, concluding that such laws provide for greater choice and lower costs for patients.
This “turf-war” between optometrists and ophthalmologists has paralleled other shifts in providing health care. Podiatrists and medical doctors have long feuded over the rights of the former to do complex foot and ankle surgeries. The “scope of practice” of podiatrists are usually delineated in state laws.
Licensed advanced practice nurses are now allowed in many states to provide health care without supervision by medical doctors, and even operate their own primary care clinics.
Much of the health care that used to be provided by doctors are now performed not only by nurse-practitioners but also by
Certified Physician Assistants (PA’s) who are theoretically supervised by physicians, but often are the primary care provider in many hospital settings.
Is the “nurse” who cares for you at bedside a Registered Nurse? There is a good chance that person is a CNA (certified nursing assistant) with less training than a registered nurse. And the provider you first encounter in the doctor’s office may be a licensed Medical Assistant, who also has less training than a registered nurse.
An incentive to broaden the range of medical services that can be performed by those who do not have a medical degree is, of course, money. Salaries of the “ancillary” providers are less than those of MD providers, and many of the procedures can as readily be done by those with less training. But some students of the U.S. health care laud this trend because it opens more access to needed medical care in under-served communities.
There is a national and a world-wide shortage of trained medical doctors. The shortage of doctors in the U.S. is alleviated to some extent by the many foreign-born doctors who come here to practice. But each of those mean one less doctor in their country of origin. For years, the shortage of health care providers in some poor countries was met by Cuba sending its lesser-trained providers to those countries. U.S. observers noted that this effort met a very real need for basic medical care to be provided by less-expensive methods and means. It now appears that the U.S. is moving in the direction first pioneered by Cuba.
