The Future Of American Health Care: Nurse-Based Care

nurse-based care.jpgIn order to control the unsustainable increases in the cost of our health care, Americans are going to have to transform the doctor-based model of care. Our doctors are already, by a wide margin, the highest paid in the world.
Doctors’ high pay is not some natural occurrence: the American Medical Association keeps a tight grip on the number of accredited medical schools and thereby artificially limits the number of doctors entering practice. Controlling the supply of doctors has the effect of driving up the price for their services.
The AMA’s policy has created an artificial scarcity of doctors. Currently, there is a shortage of 7,000 physicians, mainly in primary care. Over the next ten years one-third of physicians will retire, and the shortage will increase to 100,000 physicians across all specialties.
To succeed in driving down the cost of health care, we are either going to have to produce more doctors or reduce the demand for their services. And it appears that the direction we are moving in is reducing the demand for doctors’ services by allocating more of their customary responsibilities to nurses.
The Institute of Medicine recently issued a report on the subject entitled, “The Future of Nursing: Leading Change, Advancing Health.” And this week The Times featured a great article on the topic.
A lot of the doctors I speak to believe that in the next decade or so many patients will begin seeing nurse practitioners as their primary care. A move away from doctor-based care may benefit us all if it helps us save on health care.
But I would like to see someone loosen the AMA’s stranglehold on the supply of physicians. A few months back Matt Yglesias had a great series of posts on eliminating artificial barriers to entry into a variety of professions, including medicine. In a perfect world, we wouldn’t be facing a shortage of doctors at all.