The ACP Advocate Blog
by Bob Doherty
Thursday, March 19, 2009
Do surgeons believe that non-physicians can "substitute" for primary care?
Yesterday, ACP President Jeffrey Harris, MD, FACP, testified at a hearing of the House Committee on Small Business examining the impact of President Obama's budget on "small providers."
(Maybe because I am still in the St. Patrick's Day mindset, I keep thinking of "small providers" as being the U.S health care system's equivalent of leprechauns, the legendary "little people" of Irish lore. I digress, though.)
Dr. Harris' statement made a strong argument on why the federal budget should support primary care physicians, especially those in smaller practices, noting that 82 percent of office visits are furnished in practices with five or fewer physicians.
I was struck, though, by the testimony of John Preskitt, MD, who was testifying on behalf of the American College of Surgeons. His statement makes the argument that the U.S. is also facing a shortage of surgeons, including but not limited to general surgeons. Fair enough: I think there is little disagreement that general surgery is also facing a shortage. I found one part of his argument to be quite provocative, though, to physicians in primary care specialties:
"With trauma care and surgical emergencies, there are no good substitutes or physician extenders for a well-trained general surgeon or surgical specialist. Surgical training is vastly different from other physician training programs. Mastery in surgery requires extensive and immersive experiences that extend over a substantial period of time. Surgical residencies require a minimum of five years and often several more years for specialties such as cardiothoracic surgery. However, the prospects of declining payment coupled with rising practice costs; increasing liability premiums and the escalating threat of litigation; a crippled workforce leading to more on-call time, higher caseloads, and less time for patient care; and an uncertain future for the U.S. health care system understandably deter would-be surgeons from making the extra sacrifices necessary to become a surgeon." (emphasis added)
Is the American College of Surgeons really implying that there are good non-physician substitutes for primary care physicians, but not, of course, for surgeons because "mastery" of surgery is so much more difficult and takes so many more years of training than primary care?
The American College of Physicians recognizes that nurse practitioners and physician's assistants are valuable members of the primary care team, working collaboratively with primary care physicians. We have also unequivocally stated that their skills are complementary, not equivalent, and that workforce policies "should recognize that training more nurse practitioners does not eliminate the need nor substitute for increasing the numbers of general internists and family physicians trained to provide primary care."
Today's questions: What is your reaction to the American College of Surgeons statement "that there are no good substitutes or physician extenders for a well-trained general surgeon or surgical specialist ... Surgical training is vastly different from other physician training programs"? Do you read this as implicitly stating that non-physician extenders can substitute for primary care doctors, and if so, how would you respond to this assertion?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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