Think Outside the Box for Patient Care Models

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Where does this all stop? The more Iread and research, the more I have to wonder when the medicalcommunity is going to change? Will it be necessary to legislate atthe federal level? Or will the states step up and learn tocooperate? With the information that I am finding, it is doubtfulthat the individual states will learn to cooperate because of heavylobbying by the different medical groups in their state. Each groupseems to think that they have the propriety right to control medicinein their state.
Reciprocity is a word used to describecooperation among states and is the hallmark for private individuals,certain industries or occupations, and some professions. To themedical community, the word reciprocity is a word to be avoided anddowngraded at all levels. Private citizens can obtain a driverslicense in their state of residence and are allowed to drive in anystate and even in most countries around the world. Truck drivers andbus drivers for hire can obtain a commercial drivers license in theirstate of residence and drive in any state and many countries.
Yet the medical profession limits thelicense to practice medicine to one state only and to be able topractice in another state, the doctor must apply for a license and beaccepted by that state to practice medicine in that state. They mustbe physically present to apply and meet the requirements. Plus thefees for each state must be paid to continue practice.
With the coming shortage of physiciansin the USA in the years ahead, laws will need to be changed so that adoctor licensed in one state may practice in another state withoutthe legal hoops to jump through. To accomplish this, it willprobably be necessary to have federal legislation that will negatestate laws and allow this to happen. A federal register may benecessary to maintain records of doctors practicing across statelines. Under current laws in many states, medical associations havecrippled many of the practices that are needed to replace theshrinking numbers of physicians.
At present, we have estimates andreally guesstimates of the physician shortage coming. We know thatthe numbers of people entering the medical profession is decreasingand that many doctors will be retiring in the next ten years. Using the figures from the American Medical Association, it is estimatedthat by the year 2020, there will be a physician shortage of 91,500. This will mean not seeing your doctor as often and appointments thatwill be delayed with longer waits between visits. Missing anappointment will be penalized with even longer times betweenappointments.
This is the reason to start thinkingoutside the box now. Telemedicine will need doctors that canpractice across state lines and an expansion in nurse practitioners,physician assistants, and nurses to assist doctors in telemedicine toexamine patients in rural communities and allow physicians toprescribe medications that the NPs, PAs, and nurses are seeing. Evensome nurses may be used to examine some patients. Then using somepharmacists to see patients and possibly use telemedicine to reportto doctors and obtain prescriptions. It may also be necessary forsome NPs, PAs, and Pharmacists to have prescription authority forprescription renewals and some medications. Federal laws willprobably need passing to make this happen, as again current laws inmany states supported by different medical organizations have or willcripple this going forward.
With concierge medicine expandingrapidly because of cuts in Medicare and insurance companies’reimbursements for procedures, the doctor shortage may become evenmore critical. In my own experience of working as a volunteer peermentor for type 2 diabetes patients of two doctors in a conciergepractice shows that for many chronic diseases and illnesses this maybe meaningful use of resources in a shared medical appointmentsetting. Other doctors are also using peer mentors and even a fewdoctors are using knowledgeable patients in peer-to-peer settings.
Even retail clinics and communityclinics are gaining in acceptance, especially among patients. This blog brings up a type of clinic that does exist, but I do have towonder if it will remain in existence in the workplace of largeemployers, as is the case in California. She does make an excellentcase for this work place clinic in her second blog.
We all are optimistic even with thecoming shortage of physicians. However, many physicians’organizations are still lobbying heavily to prevent further expansionof telemedicine, practice across state lines, even limiting conciergepractices, and in general working hard to create a medical monopolyfor physicians and discouraging any type of thinking outside the box. With most physicians now working for hospitals, they have gained apowerful ally in discouraging many of the medical experiments.