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Benchmarks of Value – April 29, 2013

April 29, 2013

Hello everybody:

The P-E’s coverage of the conflict between medical providers over state legislative proposals that would expand scope of practice for non-physicians (“Medical school money in health care turf war mix,” April 19) concisely summarized concerns surrounding the soon-to-explode numbers of people who will need care under the Affordable Care Act (ACA).

Chief among these is that while there aren’t enough primary care physicians to meet the expected demand, physician groups are aggressively opposed to expanding scope of practice regulations for optometrists, nurses, and pharmacists so that they could perform some basic primary care functions and help address the growing need in that area. Their argument is that what’s needed are more doctors, and thus more medical schools like the one planned at UCR – not expanded roles for non-physicians.

But solving the challenge posed by the increased need for primary care is not this cut and dried. It is not an either/or situation, where one side “wins.” This notion of a “turf war” between interest groups ignores the most important person of all, the one in whom every health care provider should be most interested – the patient. How do we best address their health issues? How do we ensure they receive the care they need in a timely fashion? How do we make them aware of all the medical resources available to them in the brave new world created by the ACA?

The myriad care and accessibility problems created by the Act – problems resulting from a noble cause, to be sure – cannot be solved by the current system, and require a multi-disciplinary approach. Here’s why:

The list goes on. Dentists, optometrists, physical therapists, physician assistants … all are capable of offering more expert care than they are allowed.

Health professions universities across the country have for many years recognized the importance of a team-based approach to patient care, with some – including WesternU – going so far as to develop special courses of study (interprofessional education) to emphasize this new paradigm. The effort behind such initiatives is driven by the recognition that most health-sciences disciplines teach a broad array of skills that – despite being drastically underutilized in the current care environment – could go a long way toward distributing the burden for many primary care services across several fields, rather than having it fall solely on the shoulders of already overtaxed primary care physicians. This has the added benefit of fully integrating all members of a health care team toward a single goal – better health for the patient.

Today’s health-sciences graduates could do a lot to address the current and looming primary care shortage in our country – if only they were allowed to do so. The nearly 1,100 pieces of scope-of-practice legislation working their way through state legislatures across the country, including several in California, are testament to the fact that the traditional methods of administering primary care services can’t continue if demand is to be met.

Now is the time to adopt a truly team-based approach to health care, and to help those most in need of these services – patients – by working collaboratively not only to graduate more physicians, but to expand scope of practice in other health-care disciplines.