October 22, 2012

The Under-appreciated Professions


The four occupations included in this blog are among the most under appreciated professions. They still can have people within the profession that are bad apples for the profession. Most are a credit to the profession and do their jobs effectively and efficiently. Physician's assistants, nurse practitioners, nurses, and pharmacists are the occupations for this discussion. All have national organizations for support and advocacy. With the looming shortage of physicians, these professionals will serve a vital role in medicine and seeing patients on a more active basis. Links to professional organizations will be the profession below.

Nurses, whether they are registered nurses or any of the 68 different types of nurses, they have a role to fill and in general do excellent in their profession. The list of 68 may not be inclusive, but shows many of the areas that nurses may become specialized for their profession. Under the physician shortages, they will need to step forward and learn how to handle an ever-increasing load. Those that can obtain some additional education quickly will be in line for promotions and work in this expanded need.

Nurse practitioners (NP) and physician assistants (PA) will find more physicians that are more willing to work with them and expand their roles under the physician shortage. They will need to be cautious, as there will still be some physicians that will not accept their role or even work with them. These physicians will do more to damage the medical reputation of themselves and those round them. Physician shortage will not be easy for those still practicing.

If some of the hurdles can be removed, nurses, nurse practitioners, and physician assistants will in some of the more rural areas, be spending more time visiting elderly patients in their homes and using video conferencing (telemedicine) or telephone if necessary. Except in the states that have passed laws requiring physicians to physically see the patients before they can issue a prescription, physicians in the rest of the states should be able to issue prescriptions with the assistance of nurses, nurse practitioners, and physician assistants. In a small number of states already experiencing physician shortage, there is some talk about amending the law to allow these medical exceptions when driving distance is an impediment to physically seeing a physician.

The position of pharmacist is still being discussed, but physician resistance for allowing any pharmacist to issue prescriptions is still strong. One state is considering situations where a pharmacist would be able to renew prescriptions especially for certain chronic diseases like diabetes. Another largely rural state is considering allowing pharmacists with certain qualifications to be able to work with physicians in a capacity like nurses. Pharmacists in hospitals, assisted living facilities, and nursing homes may be given more responsibilities and with continuing education expand their roles even further.

Some pharmacists are already expanding their own roles in some of the larger chain pharmacies and this should also be considered and supported. Too many patients do not utilize their pharmacists to prevent polypharmacy conflicts. I think that there needs to be restrictions placed on patients using one pharmacy for one medication and another pharmacy for a different medication. If nothing more, pharmacists need a technology system to be able to access by name and social security number all pharmacies within a certain parameter to search for medications being taken by a patient to prevent medications conflicts. It is not unreasonable to find patients using three or more pharmacies for prescriptions and I have a few acquaintances that use this to keep (supposedly) others from knowing what other doctors are prescribing. I suspect prescription abuse to be honest.

Depending on how critical the physician shortage becomes will determine much of the expanded role for nurses, nurse practitioners, physician assistants, and pharmacists. Those that are willing to seek additional education now will be able to capitalize later. I know of two nurses presently studying to become nurse practitioners. I have written about the role of pharmacists here and need to say that some of the questions have been answered, but not all have been explained to anyone’s satisfaction. Walgreens has even gotten even more secretive while other pharmacies have become more open and transparent in what they want for their patients. Some of this is good while some actions do raise more questions.

It will be interesting to see what happens during the upcoming physician shortage. How long will we need to wait to get an appointment, how long will it be between appointments, will emergency departments continue to exist in some rural areas, and how many minutes will we have available with the doctor during appointments? These and many more questions are clogging my brain. I can only hope that I am fortunate enough to avoid many of these problems.

1 comment:

Rick said...

Dear Bob,

What you do is also under-appreciated! Except by me. I appreciate your contribution to helping those of us who have diabetes to manage this disease.