Copied from an email from Sermo, the current House Bill includes these provisions:

p461–”Authority to allow Nurse Practitioners and Physician assistants (consistent with state law) to be in charge of a patient centered medical home.”

p463 “The term ‘primary care’ means health care that is provided by a physician or nurse practitioner who practices in the field of family medicine, general internal medicine, geriatric medicine, or pediatric medicine.”

p480 “(3) Primary care practitioner defined–In this subsection the term primary care practitioner A) Means a physician or other health care practitioner (including a nurse practitioner) who specializes in family medicine, general internal medicine, geriatrics, or obstetrics and gynecology and…B) includes a physician’s assistant who is under the supervision of a practitioner described under subparagraph A.”

Based on these provisions, it is my opinion that if this bill passes it will become the policy of the Federal Government that no physician in training should be encouraged to enter a primary care field of medicine. So much for healthcare reform. The ACP should change it’s name to the ACPNP (Americian College of Physicians and Nurse Practitioners). In order to “stay at the table” you sold out your membership.

Where is the support for primary care Dr. Doherty references? The laughable 5% bonus?

I do not agree that doing something for the sake of doing something is the right approach. Heading into this debate everyone agreed that a robust primary care workforce was necessary to improve quality and lower costs. There is no support for that in this bill. Where is the data that NP lead primary care leads to the same beneficial outcomes as physician lead primary care? Yet there it is, about to become government policy.

As an internist and academic hospitalist, please tell us exactly what it is you admire about this bill DB. Where is the disincentive for excessive scanning and procedures? Where is the support for cognition that you have championed for so many years on this blog? If this bill passes, what would you tell a college student who is interested in a career in primary care medicine – choose NP or MD? How about a 3rd year medical student?

As a practicing internist who does both outpatient and inpatient care here is what I am thinking in the wake of this bill:

Is it too late to retrain as a specialist at age 50? How can I squeeze more patients into my schedule to meet the demands of increased overhead? Should I work weekends and evenings and take time away from my wife and 11 and 7 year old girls? Should I go to an all cash practice or is that too risky? Should I close the office and look for work as a hospitalist? I imagine that most of the others who do what I do are thinking the same things.

Currently Medicare, Medicaid, Tricare, and some private insurance plans for government workers cover at least 50% of the population.
The new public plan extends coverage to the population. If the new public plan is any good for a fair price and with primary care doctors willing to see the patients, then people may drop their private plans. With fewer privately-insured patients, private insurance companies will continue to conglomerate or will become nonexistent. If the new public plan is no good and even though the government will require Medicare providers to see patients in the public plan, then the plan will cause rationing of services and extended waits to get into physician offices.
Likely the new plan, which touts preventive medicine to save money, will take a minimum of five years to break even. Regardless, another health care option likely will be in effect for 2009.