Physician Outlook

Doctors Vs. “Doctors”

The Devil Is In The Details. How does the Order define a Doctor? It matters.

President Donald Trump recently signed an Executive Order in October 2019 (Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors) that proposes lower costs, the ability for patients to fund and use Health Savings Accounts, and the ability to see physicians who don’t accept Medicare.  My heart was pounding with joy as I read the Order…until I got to Section 5.


The first paragraph is wonderful, stating that within one year of the date of the Order, reforms will be made to the Medicare program to enable providers to spend more time with patients.  The devil, however, is in the details: how the Order defines a “Doctor.”  The AANP is pushing Nurse Practitioners to get their DNP (Doctorate of Nursing Practice), and now physician assistants can get a DMS (Doctor of Medical Sciences).  These degrees can be obtained 100% online within one year.


The Order proposes regulation that would “eliminate burdensome regulatory billing requirements, conditions of participation, supervision requirements, benefit definitions, and all other licensure requirements … that are more stringent than applicable federal or state laws require and that limit professionals from practicing at the top of their profession”


Basically, this Order is giving Health and Human Services a one-year deadline to propose a regulation to ensure that services, “whether done by physicians, PAs, or NPs are appropriately reimbursed in accordance with work performed rather than the clinician’s occupation.” So, the “haves” will continue to see “real” board-certified, properly trained physicians, while the “have-nots” will be seen by lesser-trained, less-expensive, online-trained “Advanced Practice Providers.”


Let’s be clear.  I highly respect nurses, well-trained, experienced NPs and PAs.  I fully support my 19-year-old daughter’s career choice to become an orthopedic PA.  But that respect doesn’t erase my concerns.


This is my comment to President Trump:

When an individual boards an airplane, the expectation is that the pilot is the “captain” of the aircraft, and that s/he has been through years of rigorous training. We don’t allow online/flight simulator-trained flight attendants dubbed “Advance Practice Pilots” to replace actual pilots. The practice of Medicine is much more complex than flying a plane. It is a team-based physician-led art form that works best when the patient and physician are at the center of the relationship. NPs and PAs are important team members but are not physicians. Insurance companies, hospital administrators and middlemen have hijacked the practice of Medicine for profit. It is time to strip them of their power and expose their dirty tactics. 


"Originally published in Hispanic Outlook magazine"

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