No Appointment? See a Nurse Practitioner

A nurse practitioner is a great idea, my doctor has one, he calls the person a "physician's assistant." Could someone advise hospitals to do that for the flu and cold people in the emergency (reducing the DSP cost)? So much protocol to do a sensible thing typical.

Part of what sustains the current system are the payments from judgments on personal assets from the more affluent non-insured that were treated. Insurance companies get volume discounts to give a hospital all their business, medicare gets a discount, so someone makes up for those discounts. If those people become insured, then where is the discount? In the cost savings, which is still not clear.

It leaves the question of what costs so much. In California some of the discount was funded by reduced care, the voters passed a law to require a sufficient number of nurses per ward to insure enough nurses. I can see Obama wants more people to pay into insurance, a strain on budgets in a bad economy, essentially the discount coupled with reduced end-of-life care and digital records. Generally I feel that insurance is a trend of late, we have two wars of 7 years for insured safety against terrorists still going with end uncertain, an insured stock market scheme that nearly ruined the United States economy (CDS's), and now we feel it's time for health and a spare trillion dollars from somewhere. We should start by identifing costs specific to one hospital in my opinion, see what is wrong in the costs (specific to labor, materials, facility) of that sampling.

do not side with big business and the insurance companies and pers drug companies.....side with the AMERICAN PEOPLE AND BARACK OBAMA .........THAT IS THE REASON HE WAS ELECTED...WHEN IT COMES TO HEALTHCARE IN OUR COUNTRY.

do not side with big business and the insurance companies and pers drug companies.....side with the AMERICAN PEOPLE AND BARACK OBAMA .........THAT IS THE REASON HE WAS ELECTED...WHEN IT COMES TO HEALTHCARE IN OUR COUNTRY.

Colleen, Your views were sincerely stated. As a fellow RN of 35 years, I understand somewhat where you are coming from but have to, unfortunately, agree more with Thunderpup who commented above. I've been attended to and worked with several nurse practitioners and have found many of them lacking in experience. Education is important, of course, but in the field of medicine most of us know we learned far more from the actual bedside, skin touching, feet aching type of nursing. Nurse practitioners who practice alone can be dangerous. They are not physicians.
My daughter who is a Master's trained Speech Pathologist recently had an experience in one of our local urgent care centers. This NP who treated her was rude, wrong and dangerous. She spent most of the time asking my daughter why she had waited until 6:30 to come into the urgent care when they close at 7:00 PM; then she went on to tell her she just had a virus and should expect it to last another four weeks. My daughter had already been ill for two weeks, with a fever and a severe headache with sinus drainage. As a patient she was made to feel "less than" she should have when leaving there with nothing but inadequate advice and nothing helpful. The next day my daughter got in to see our PCP and was placed on antibiotics for a severe sinus infection.
The best NP's I've worked with do so in conjunction with a physician who is actually present with them for advice, guidance and security. Too many NP's begin to believe they are doctors. If they want to be doctors, then they should go to medical school.
Thunderpup was also correct about the nursing shortage. Why can't nurses be content to pursue the care they are trained to give? Why can't they find fulfillment in that alone? So often it is the staffing shortages, demands of the floor care and the lack of respect they receive from doctors and the administration of hospitals. It's time for nurses to be appreciated as the caregivers they are originally trained to be. We need to look very seriously at this problem and the drop-out rate among good nurses who can't take it anymore. Thanks for your time. Sue Falkner Wood

This is a perfect example of why the health care debate if so fractured and fractious. Ms. Conway-Welch identifies a problem precisely - "many physicians no longer see Medicaid/Medicare patients because the fees paid to them by the government are actually lower than the cost of that care.", but she then goes on to offer a self-serving "solution" which complicates the system, adds new costs, and brings yet another special interest to the government feeding trough.

The national shortage of nurses is more severe than the physician shortage, yet Ms. Conway-Welch does not address the fact that advanced practice nurses are subtracted from the traditional nursing work force where the need is greatest.

Our health care system will not be well served by dumbing down the care providers corps with "semi-docs". Most of the time, a cold is a cold, but when it's not, even an experienced physician needs the power of repetition to sort it out. Going from one anonymous "nurse in a box" to the next simply prolongs the agony and decreases the likelihood that a definitive diagnosis will be made early enough to prevent permanent damage or death. The medical home doctrine supports this notion of returning to a system in which "your" doctor cares for you, as opposed to our current state of anonymous, fractured and ineffective care providers treating the symptoms you display today.

Most Americans old enough to remember it yearn for the days when they saw their family doc for all their needs, not because insurance required it, but because they knew there was one person who knew them, whom they trusted, and who had the willingness and ability to direct them through the health care system as needed. Today's health care has destroyed that practice style, but adding partially trained "symptom treaters" to the mix does not solve any problems.