It's a fact that extending healthcare to millions of currently uninsured people is going to place huge strains on the system. In California, it's suddenly dawning on the powers-that-be that there won't be enough doctors to serve all these new patients.
I know! Shocker, right?
What's actually shocking is California's proposed solution: Allow people with little to no actual medical training to serve as primary care providers. This includes pharmacists and optometrists. Granted, today all pharmacists and optometrists hold doctoral degrees. But it wasn't so long ago that becoming a pharmacist required just a bachelor's degree. In fact, prior to the late 1990s, a high school student could go directly into a 5-year pharmacy program. And while optometrists complete four years of post-graduate education, it's almost all focused on the eyes and vision care.
Here's a quote from a Los Angeles Times article that illustrates my concern about allowing professionals like optometrists to act as primary health care providers:
[California State Senator Ed Hernandez (D-West Covina), an optometrist] said he often sees Medicaid patients who come to his La Puente practice because they have failed their vision test at the DMV. Many complain of constant thirst and frequent urination. "I know it's diabetes," he said."Really? Just because someone failed an eye exam at the DMV and has "constant thirst and frequent urination," this man "knows" the patient has diabetes? This surprises me because, as a nurse, I can think of several other potential diagnoses with these symptoms. These patients well may have diabetes, but I wouldn't automatically leap to that conclusion.
And this is what bothers me about the pending California legislation. I don't think individuals without direct patient care education and experience should be allowed to magically become "primary care providers." I have the utmost respect for pharmacists, but their doctoral education is specific to medication. Ditto for optometrists, but their post-graduate education is pretty much limited to eye issues. None of these folks have experience performing patient exams.
Furthermore, as I mentioned earlier, the "Pharm D" or "Doctor of Pharmacy" degree has only been around since the late 1990s. The legislation presumably would grandfather in any pharmacist (or optometrist), regardless of their level of education. I don't know how long optometrists have been required to obtain a doctoral degree, but does it really matter? Do you want an optometrist coordinating your care for, say, lung cancer?
The proposed California legislation would relax restrictions on nurse practitioners and physician assistants, allowing them to practice independently. I find this a much more reasonable solution. In many states, including New Mexico, nurse practitioners have practiced independently as primary care providers for years. Numerous studies support the safety of independent practice by nurse practitioners. I'm sure the same would be true for PAs.
Although the education requirement to become an NP or PA is lower (usually a master's degree) than that to become a pharmacist or optometrist, NPs and PAs have actual medical education. They've studied pathophysiology extensively. They know how to take a medical history -- and know what items should raise red flags. In my experience, NPs and PAs are well aware of when to refer a patient up the ladder to an MD. Partly that's because they've worked in the system and view patient care as a team effort.
The anarchist in me wants to love this proposed California legislation. Let almost anyone with some sort of master's or doctoral degree in the biological sciences act as a primary care provider. Let individuals decide for themselves whether or not they want to trust an optometrist or pharmacist with their general health and well-being.
But the more savvy libertarian in me understands that the proposed California legislation won't give people a choice in the matter. Some people will be forced onto unqualified "primary care providers" because the real doctors will have to stop taking new patients. And when a person's choice in such an important matter is taken away, that's real cause for alarm.
Welcome to Obamacare: The pharmacist will see you now.
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