Supply and demand is perhaps the most basic principle in economics, or at least one I remember from so many years ago. If we are going to bring the costs down in healthcare, we need to take as many bottlenecks out of the system as possible and really increase access to care. We should also make it as efficient as possible, making sure every provider practices “up to their licensure” as the experts are fond of saying. Another way of saying this is to allow everyone to concentrate on what they have been trained to do and push work down that can be handled by those less trained.
One way we can make this happen is to make full utilization of nurse practitioners and other healthcare personnel. Last week, the Washington Post had a very interesting piece on NPs and how they will have to become more fully utilized as healthcare reform is fully implemented. There are currently about 155,000 NPs in the country and they will be critical to filling the gap of PCP coverage as office visits begin to increase again and as more people enter the system.
The key to making this work is to allow NPs to practice up to the level of their training. They are allowed to practice without restrictions in 16 states and with varying degrees of control in the others. Last year, the New England Journal of Medicine looked at the situation and determined that there was no evidence that the level of care was any better in areas where there was greater control. Why not come to some national consensus that would allow full participation by NPs across the country? Note in the NEJM piece the huge cost savings that would result if this happened.
Perhaps we should take this a step further. Last week was International Nurse Week which culminated on Florence Nightingale’s birthday on May 12. The attached blog notes that there are 3 million nurses in the United States and 32 million throughout the rest of the world. It points out that 90% of the healthcare in the world is delivered by nurses rather than physicians. I am not suggesting that this same thing should happen in the US, but perhaps we could look for ways to make better use of non-NP nurses as well.
While we are at it, how can we increase the role of the 275,000 pharmacists in the US? The FDA is currently floating a proposal to expand the use of pharmacists by allowing them to play a greater role in the treatment of chronic diseases such as hypertension. Perhaps, we need more drugs taken over the counter or even to be dispensed by pharmacists behind the counter with less input from physicians. Around the world, this is more the norm than in the US.
When talking with physicians today, one of the most prevalent trends is the automation of healthcare delivery. More and more decisions are actually taken away from the PCP and they are required/encouraged to follow an algorithm for care. This is good in that much of this is built around evidence based medicine. As more of primary care becomes like “factory” work, why not allow less trained professionals such as nurses and pharmacists to make routine decisions for patients who do not fall outside the standard care guidelines. This would allow PCPs to concentrate on the trickier cases, that would require perhaps moving beyond the standard care guidelines. While we are at it, lets do everything possible to automate the administrative work so that everyone can spend time with patients, not paperwork.
For those of us in healthcare marketing, it must be obvious that change is coming. Already NPs, PAs and pharmacists play significant roles in our business. Are we preparing for the day, perhaps in the near future, when they play as big, if not a more important role than physicians for many diseases? I always thought that marketers should try to drive business wherever they can, and unlike sales calls which are very expensive, direct marketing efforts should go to as broad a group of potential users as possible. Right now I am pretty sure there are 200,000 nurses and 100,000 pharmacists that are just as important as many of the physicians we currently work with every day. Perhaps we need to broaden our thinking so that as the provider gap is getting filled, we are ahead of the curve.