[CCM-L] Busy weekend - nursing shortage

[Jane Harper]

Perhaps so, Lou -- but it's never going to stop until economics is no longer
the issue.  Organized medicine (not to be confused with individual
physicians) continues to insist on absolute control over everyone who
approaches a patient, in spite of outcomes research, fair trade legislation,
the ethics of patient choice, and the needs of individual patients.  As the
margins in medical practice get smaller, the tyranny gets worse.

This is absolutely to the detriment of patient care, and yet it never goes
away.  I watch the physicians with whom I work respond to questions from
bedside nurses with "Because I'm the surgeon, that's why."  I see
heavily-funded physician lobbies oppose anything that will widen patient
choice in care providers, in spite of outcomes research that shows quality
primary care is provided by midlevel practitioners, and at a substantial
cost savings.  I see the AMA insult patients' intelligence by saying that if
anybody other than a physician (or a podiatrist, oddly enough) introduces
herself as "Dr. So-and-So" patients will get confused, and so it should be
ILLEGAL to do so -- something which NEVER came up until there was a lot of
publicity about doctoral programs in nursing.  Psychologists, physical
therapists, pharmacists, veterinarians, and chiropractors have been
introducing themselves to people as "doctor" for years, so why NOW is this
such an issue, I wonder?  Nobody I know with any kind of doctorate, clinical
or academic, is trying to defraud patients by masquerading as a physician.

Gratefully, and notably, I never see this kind of behavior on either of
these lists, and I salute all my colleagues who have managed to see past the
propaganda put out by their professional societies.  But as recently as last
March at the Las Vegas meeting I was challenged by a trauma surgeon from my
alma mater, the University of Cincinnati, who told me that they will never
accept nurse practitioners into the trauma service there because we all want
to be surgeons!  (As if in this day and age anybody who wanted such a thing
couldn't have it ... it's not the 1970s anymore.)

We have GOT to get past this if the system is going to be fixed, but if
anything I see it getting worse instead of better, and steadily so since I
began practice in the 1980's on the verge of prospective payment.

Like I said, economics trumps everything.  Patient choice, quality care ...

Jane

PS:  With the looming huge shortage of general surgeons, and the increasing
nature of general surgery becoming a coordinating service among specialties
rather than someone who spends a lot of time in the OR, who do you suppose
will wind up stepping up to the plate to fill in the gap???  No NP I know
wants to be the one to decide when and whether someone needs surgery, but
there are rafts of us who can do (and are doing) the coordination of care
and management of complications after that decision is made.

OK, I'll get off my soapbox now, and I hope you all understand that I
ABSOLUTELY do not intend to have any of my colleagues from these lists in my
sights, because this group is an amazing bunch of professionals with a
tenacious dedication to quality patient care.

/rant off


On 7/15/08 9:16 AM, "LNMolino at aol.com" <LNMolino at aol.com> wrote:

> Gee this seems to be an US against THEM and there will ALWAYS  be an US and
> a THEM in all professions.
>  
> Louis N.  Molino, Sr., CET
> FF/NREMT-B/FSI/EMSI

-- 
Jane Harper, PhD(c), RN, APN
Trauma Nurse Practitioner, Rockford, IL