Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform.
One of the criticisms physicians hear from non-physician provider organizations is that doctors are engaged in a “turf war,” or that nurse practitioners (NPs) are working in places where physicians “won’t go.”
But in talking with my colleagues, I have found that physicians want to work in rural or underserved areas, but are being replaced by lesser trained (and less expensive) non-physician providers. Unfortunately, this substitution may harm our most vulnerable patients—those who are most likely to need the skill and care of a highly trained physician.
Take the example of Martin Young, MD, a pediatrician who attended medical school and fellowship in the United Kingdom and then completed a second fellowship at Boston Children’s Hospital. Young told me he lost his position as a primary care pediatrician in rural practice to a family nurse practitioner.
Young, a 30-year veteran physician who previously served as an assistant professor at the Tulane University School of Medicine, was recruited by a rural hospital to start a primary care pediatric practice in 2012. “I picked up and moved across the state to live in a small town as was stipulated in my contract,” Young told me.
The practice was a success. After three years, Young needed help, and the hospital hired a pediatric nurse practitioner to join him. “Everything went well for two years, but then the hospital began to have financial difficulties,” he said.
One day, Young was introduced to a family nurse practitioner, who the administration told him would be joining the practice. Within a few months, Young said he was called into the administration office and given his 90-day notice of termination.
“From a financial point of view, I completely understand the hospital’s action. From a patient point of view, it’s like Russian Roulette,” said Young. “The clinic that I started is being run by two NPs with no physician pediatric cover. My departure has also meant that there is no physician to provide inpatient care for kids at this hospital—the NPs will do the admissions.”