Doctors Protecting Their Turf

Healthcare reform is unlikely to reduce the cost of healthcare for one simple reason. Universal coverage will increase the demand for heathcare services while the supply will remain constrained. We already have a shortage of healthcare professionals and at least part of the reason for that is the top down cost controls imposed by Medicare. In many states, it is difficult for Medicare patients to find doctors willing to take them. In MA where they have enacted a universal coverage mandate, the waiting times for doctors is rising rapidly as the demand outstrips the supply.

One way to increase the supply of healthcare services is to allow nurse practitioners to provide basic medical care. A number of retailers such as Walgreens and Walmart are already doing this. These clinics provide basic medical care and refer patients to doctors for more complicated procedures.

Of course, doctors aren't happy about this since it reduces the demand for their services:

Despite better protections from malpractice lawsuits and lower malpractice premiums, Texas has a doctor shortage. Nevertheless, the Texas Medical Association took every step to ensure physicians will have a tight rein on the activities of well-trained nurses.

The barrier against nurses will continue to keep low-fee retail health clinics, such as those operated by Walgreen and CVS drug store chains, from expanding in Texas. The state law requiring doctor supervision adds too much cost to the clinics.

Texas has only about 85 of the 1,200 retail health clinics in the nation. San Antonio does not have a single one. The clinics are popular wherever they exist because nurse practitioners can treat common ailments and minor injuries with little waiting time and fees that average about $60, much less than emergency rooms. The clinics operate evenings and weekends and accept insurance plans.

The clinics would represent real health care reform, especially in Texas. Most of the state, 179 counties out of 254, is classified as medically underserved. Among them are 45 metropolitan counties, including Bexar.

Rules such as those that require a doctor to supervise a nurse practitioner are enacted under the banner of consumer protection, but what they really are is a way to limit competition in the market place. The AMA (and the state versions of same), like any professional organization, is primarily interested in protecting its members.