August 20, 2012
Think Outside the Box for Patient Care Models
Where does this all stop? The more I read and research, the more I have to wonder when the medical community is going to change? Will it be necessary to legislate at the federal level? Or will the states step up and learn to cooperate? With the information that I am finding, it is doubtful that the individual states will learn to cooperate because of heavy lobbying by the different medical groups in their state. Each group seems to think that they have the propriety right to control medicine in their state.
Reciprocity is a word used to describe cooperation among states and is the hallmark for private individuals, certain industries or occupations, and some professions. To the medical community, the word reciprocity is a word to be avoided and downgraded at all levels. Private citizens can obtain a drivers license in their state of residence and are allowed to drive in any state and even in most countries around the world. Truck drivers and bus drivers for hire can obtain a commercial drivers license in their state of residence and drive in any state and many countries.
Yet the medical profession limits the license to practice medicine to one state only and to be able to practice in another state, the doctor must apply for a license and be accepted by that state to practice medicine in that state. They must be physically present to apply and meet the requirements. Plus the fees for each state must be paid to continue practice.
With the coming shortage of physicians in the USA in the years ahead, laws will need to be changed so that a doctor licensed in one state may practice in another state without the legal hoops to jump through. To accomplish this, it will probably be necessary to have federal legislation that will negate state laws and allow this to happen. A federal register may be necessary to maintain records of doctors practicing across state lines. Under current laws in many states, medical associations have crippled many of the practices that are needed to replace the shrinking numbers of physicians.
At present, we have estimates and really guesstimates of the physician shortage coming. We know that the numbers of people entering the medical profession is decreasing and that many doctors will be retiring in the next ten years. Using the figures from the American Medical Association, it is estimated that by the year 2020, there will be a physician shortage of 91,500. This will mean not seeing your doctor as often and appointments that will be delayed with longer waits between visits. Missing an appointment will be penalized with even longer times between appointments.
This is the reason to start thinking outside the box now. Telemedicine will need doctors that can practice across state lines and an expansion in nurse practitioners, physician assistants, and nurses to assist doctors in telemedicine to examine patients in rural communities and allow physicians to prescribe medications that the NPs, PAs, and nurses are seeing. Even some nurses may be used to examine some patients. Then using some pharmacists to see patients and possibly use telemedicine to report to doctors and obtain prescriptions. It may also be necessary for some NPs, PAs, and Pharmacists to have prescription authority for prescription renewals and some medications. Federal laws will probably need passing to make this happen, as again current laws in many states supported by different medical organizations have or will cripple this going forward.
With concierge medicine expanding rapidly because of cuts in Medicare and insurance companies’ reimbursements for procedures, the doctor shortage may become even more critical. In my own experience of working as a volunteer peer mentor for type 2 diabetes patients of two doctors in a concierge practice shows that for many chronic diseases and illnesses this may be meaningful use of resources in a shared medical appointment setting. Other doctors are also using peer mentors and even a few doctors are using knowledgeable patients in peer-to-peer settings.
Even retail clinics and community clinics are gaining in acceptance, especially among patients. This blog brings up a type of clinic that does exist, but I do have to wonder if it will remain in existence in the workplace of large employers, as is the case in California. She does make an excellent case for this work place clinic in her second blog.
We all are optimistic even with the coming shortage of physicians. However, many physicians’ organizations are still lobbying heavily to prevent further expansion of telemedicine, practice across state lines, even limiting concierge practices, and in general working hard to create a medical monopoly for physicians and discouraging any type of thinking outside the box. With most physicians now working for hospitals, they have gained a powerful ally in discouraging many of the medical experiments.