Letters: Readers comment on Medical Economics stories

Midlevel exceptions

I read with interest your article on midlevel providers ["Midlevels: Boost or burden?" September 5, 2008]. Although the article addressed the potential pluses, it did not discuss the unintended consequences of midlevel providers.

Physicians need to be physicians and see every patient whose shadow crosses the threshold of their office. The midlevels I am acquainted with are good people. They truly intend to be "healers." The greatest problem is that in time, they are viewed by larger health systems as a substitute for physicians.

Midlevels, as a rule, work bankers' hours, and the physician still has to be on backup call.

Our local hospital has four midlevels and two CRNAs (certified registered nurse anesthetists). Two of these midlevels staff the ED during daytime hours, without any physician present in the ED.

Incidentally, I had hired and trained one PA and one ARNP in my practice many years ago. I now look back and consider this two of the bigger mistakes I have made in solo practice.

THOMAS YOUNG, DO
Creston, Iowa

THE TECH WILL SEE YOU NOW

I must not get it. I went to medical school after going to pharmacy school. I aspired to be an internist, stomping out disease left and right. In the 15 years I've been practicing, I've seen insurance companies overrun and completely turn the doctor-patient relationship on its head, I've seen PHOs and physician groups take on patient responsibility and go bankrupt. I have seen formulary restriction promote profit and not patient well-being. The list goes on and on.

I was recently given "stars" by United Healthcare. Whoopie. But the creation of NPs and PAs is the stake in the heart of all physicians. Sadly, we are too greedy and stupid to see it coming.

Let me make one thing clear: When a PA or NP can get paid the same as a physician does, have the same level of abilities, or be preferred over a doctor . . . we've got problems. In 5 to 10 years, all GPs, internists, and FPs will be gone. You can rest assured when you or your wife or kid is sick, they'll see a tech! Why on earth would anyone go to med school to compete with a PA or NP?

And that lawsuit the patient sued you for over the PA's misdiagnosis? The new kid in town representing you is the "LA"-lawyer's assistant. The lawyer only takes $100 million cases.

DR. BRIAN MARKS
Scottsdale, Arizona

A SKEPTIC IN BILLING

I work in billing, and I am a man ["What your medical billing service says about you," June 20, 2008]. The man could have pressed "3" the first time around and had someone call him back if he was as upset as he claims. If that had been a live voice on the phone, he still would have been upset and probably would have cussed out the person he was talking to and asked to speak to his supervisor. So no, I'm not buying that.

He must also be scared of men-he felt intimidated by a man's voice? I'm sorry to sound crude, but he knew bills were coming in for his wife for the past year. Maybe it's just me, but when a patient has problems with his bills, all of a sudden it's the fault of the billing company every time.