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Tuesday, May 2, 2017


 
 
Is There “Really” A Doc Shortage?


Are we really going to have a doctor shortage over the next decade?  Or, could we provide more cost effective care through the utilization of NPs and PAs?  In that case, there might not really be a doctor shortage, as some believe.

I agree that greater use of NPs and PAs for follow-up and routine care would be more cost effective healthcare.  However, some patients only seek medical care on an as needed basis.  A new health problem might be their rare visit to see a doctor.  This might be a one-time chance to discover other untreated conditions, which might go “unexplored” by a PA or NP.  When I go to a doctor, I want to pay for that doctor’s “blink”, but I will discuss that idea a little later.
First, I want to discuss a theory from my teacher education days. The theory was called “Bloom’s Taxonomy” and dealt with the incremental levels of learning a student experiences with new subject matter.  To illustrate, remember when you were in high school and your teacher announced an upcoming test?  All the students would plead for a True/False exam.  I now know why.  True/False tests are at the lowest rung of learning.  The student has only to recognize the simplest level of knowledge about the material, whether the question was “True” or “False”.  The next levels up were “matching”, followed by “ fill in the blank”, and writing a complete sentence for the answers.  The highest levels on the learning curve were concept formation, synthesis, and prediction.  How does this idea relate to the projected shortage??
The amount of training required for a PA and a NP are 1-3 years post college graduation (the NP requiring a nursing degree).  The amount of education and training a doctor pursues is generally 7+ years after a college degree.  As I mentioned before, my 3 family members have trained for 7, 10, and 11 years post college. I would suggest that there is a significant difference in the knowledge level acquired in the training years between PAs/NPs and MDs.  The additional years spent in learning by an MD would allow for significant exposure to the learning levels of concept formation, synthesis, and prediction.  How can we equate 1-3 years of training with 7-10+ years of training?
Now back to the idea that when I go to the doctor I want to “pay” for that doctor’s “blink”.  In Malcolm Gladwell’s book, Blink, he defines his use of the word “blink” as “the power of thinking without thinking”(1 ).  When the years of study, experience, and familiarity come together an intuition exists much like the “adaptive unconscious”.  Mr. Gladwell describes this, “The adaptive unconscious is thought of, instead, as a kind of giant computer that quickly and quietly processes a lot of data…” (1) When I go to a doctor appointment, I want my doctor’s “computer brain” to bring forth the sum total of knowledge and experience acquired to date.
To answer the original question about whether there will be a doctor shortage in the next decade, I will say “Yes”.  NPs and PAs provide excellent, but DIFFERENT, levels of care than a doctor provides.  One degree does not replace the other.  I want MY doctors to have reached the upper echelons of “Bloom’s Taxonomy” in learning.  I want them to have had multiple exposures to a myriad of medical conditions, years of experience, and an “eye for the unseen”.
(1) http://www.course-notes.org/files/uploads/english/blink.pdf
http://nomatchmds.blogspot.com/