The largest problem for America right now is not terrorists threatening to kill Americans, like they killed three thousand Americans 10 years ago. (In 2008, 39,000 Americans died in automobile accidents.) No, the biggest problem is economics, a.k.a., debt. And, as post after post and most newspaper articles seem to agree, the unreasonable costs of medical care in this country are at the heart (pun intended) of the problem. We pay double what other countries pay for comparable results.
But short of radically changing to a single-payer government system of medical care, nobody seems to have a viable solution that covers everybody, although there has been some agreement in these blog pages that if we could get consumers to care about costs, i.e., to get some “skin in the game”, Adam Smith’s “invisible hand of the market” might bring down costs. To that end I previously blogged about “concierge care” as one possibility.
Now in a USA Today article (8/29/2011, p. 10B) comes perhaps another glimmer of hope in the form of clinics staffed not by doctors but by Nurse Practitioners and Physician’s Assistants. For about $59 or so you can be seen and treated for relatively minor ailments or conditions and be on your way quickly. Now obviously this is not appropriate for chest pains, broken bones, concussions or chronic conditions. But it sounds great for splinters, swimmer’s ear, poison ivy, sprained ankles and immunizations. It really shouldn’t take a doctor for such things – the treatments are straightforward. (Hmm. I wonder if these clinics can process tests like pregnancy, PSA’s, blood sugar, cholesterol, triglycerides, and HIV?) You can read the whole article HERE.
This possibility of cutting costs (and waiting time) made me wonder, though, “Can NP’s and PA’s write prescriptions?” I went to Wikipedia, that encyclopedic wonder that, being free is worth more than the hundreds of dollars people used to pay for an already out-of-date printed set. What I found surprised me. It said,
National or local (i.e. state or provincial) legislation governs who can write a prescription. In North America, physicians (either M.D. or D.O.) have the broadest prescriptive authority. Many other healthcare professions also have prescriptive authority related to their area of practice. Veterinarians, dentists, and podiatrists have prescribing power in all 50 states and the District of Columbia. Clinical pharmacists are allowed to prescribe in some states through the use of a drug formulary or collaboration agreements. In all states, optometrists prescribe medications to treat certain eye diseases, and also issue spectacle and contact lens prescriptions for corrective eyewear. All 50 States allow registered certified Nurse practitioners (ARNP’s)prescription power (with some limitations to controlled substances). Several states have passed RxP legislation, allowing clinical psychologists (PhD’s or PsyD’s) who are registered as medical psychologists and have also undergone specialized training in script-writing to prescribe drugs to treat emotional and mental disorders. Physician assistants (PAs) have some prescriptive authority in all 50 states and the District of Columbia. Florida Pharmacists can write prescriptions for a limited set of drugs.
I hail this as good news. Such clinics are not going to solve the problem by themselves, obviously, but I see their sudden emergence as evidence that the hidden hand of the market has sensed the problem and begun to respond. Hope lives, even if it’s only a glimmer.