This post was originally published on 10/3/2012
“If I had asked people what they wanted, they would have said faster horses.” Henry Ford
We keep reading about the need for more physicians, and other health care providers, to care for the expected onslaught of newly insured expected from the Affordable Care Act, aka Obamacare. There are physicians opposed to expanding insurance, because much of the expansion will be through the worst payer—Medicaid. Having to take care of more people with less reimbursement is not a future they want to see.
Some physicians decry the proliferation of Advanced Practice Clinicians (APC) (nurse practitioners, physician assistants, and others) and oppose their role because they are not as well trained as physicians. They cry, “We need more physicians!” But even though medical school enrollment is at an all-time high, it takes at least seven years to train a new physician. But a patient’s health care need won’t wait seven years. APCs provide a more immediate solution.
So, do we need faster horses? Can physicians see more patients than they do now? Or do we need something else, something as radical as an assembly line turning out faster, affordable, basic transportation?
Let’s consider the real needs, bore down to the core pains. Had Henry Ford asked one question – “What do you want? – people might have said, “Faster horses.” But what they really needed was a faster way to move themselves or their products from here to there.
Now, if we ask patients and physicians today about health care “wants,” they might say, “Yes, we need more physicians.” But what they really mean is more affordable health care efficiently and effectively delivered to more people.
Physicians, examine your own practice. There are tasks you perform that only you are trained to do. But how much of what you do every day requires all the years of training you endured? Did you need all four years of medical school and a three-year residency to manage a diabetic, diagnose and treat a URI or sore throat, or do a physical?
Does it take your skills to teach foot care or review recommendations for care for a 50-year-old male?
What if you could delegate those tasks and do what, I would wager, you really enjoy? In fact, what do you really enjoy? Managing a multiple problem patient that does require you to actually think? Or working up a complicated diagnostic challenge? Or doing surgery, instead of seeing patients with undifferentiated abdominal pain? How much of your day could you recapture if you delegated the less complicated stuff to those less trained, and less expensive, and equally eager to help?
Primary care physicians, how much of your day is occupied by the routine and simple? Non-primary care specialists, how much of your day is spent working up what could be worked up by a primary care provider (either a PCP or ACP)?
Let’s ask ourselves what we really need, and figure out a way to get there. Deliver better care to everyone that needs it, faster and more economically than it is happening now.