Dr. Paul Phinney

Viewpoints: Ease rules on who provides primary care? No

There are safer, smarter ways to serve growing pool of patients

Published: Friday, Mar. 29, 2013 - 12:00 am | Page 13A

California physicians strongly supported the Affordable Care Act because it promised first, to expand access to health coverage to all while, second, ensuring the high quality of medical practice in our state.

Those who now invoke the ACA as the sole justification for allowing non-physicians to diagnose and treat California patients and perform complex medical procedures on them are attempting to achieve the first goal by undermining the second. Allowing non-physicians to practice beyond their training can only lead to inferior outcomes, higher costs and greater fragmentation of care.

Doctors and health care experts believe that California can accomplish both of the ACA's objectives without eroding quality or jeopardizing patient safety, providing access to safe and high quality care for everyone.

After all, the new health care laws were specifically written to increase reliance on team-based care, in which physician assistants, nurse practitioners, medical assistants and other professionals work under the supervision of highly trained and experienced physicians. This model leverages the skills and experience of all health professionals and has a proven record of quality and efficiency based on clinical integration.

Proposals to expand so-called "scope of practice" would only further fragment the health care delivery system, encourage overreliance on specialty referrals, and create a dangerous disincentive away from the proven model of physician-supervised, team-based care.

Expanding scope of practice will not ensure access to care, either.

Non-physician providers are not simply sitting in the wings waiting to provide care and in fact, they provide care under supervision now.

Recklessly allowing certain health professionals to operate outside of their training puts patients in harm's way. Simply changing the law cannot duplicate the years of graduate training, full-time residencies and thousands of hours of clinical rotations physicians undergo to equip them with the necessary knowledge and understanding of complicated and hard-to-diagnose, hard-to-treat diseases.

Yes, there is a troubling physician shortage in California, especially among primary-care physicians – which is why bridging the physician gap has been a leading priority of the California Medical Association for more than a decade. But clearly, the solution isn't to devalue the primary role of trained physicians – it's to attract and retain more physicians.

The most immediate way we can add more physicians is by increasing the number of residency slots throughout the state. Assembly Bill 1176, introduced by Assemblyman Raul Bocanegra, D-Los Angeles, would do just that. The bill will follow the example of other states by creating a funding source for California residency training programs, which are now grossly underfunded.

Medical residency programs train doctors after they have earned their M.D. degree. On Day One of residency, physicians are seeing patients and have more medical training than nurse practitioners do at the height of their NP graduate education.

The severe underfunding of medical residency programs in California has forced thousands of new M.D.s to leave the state for their residencies, where the majority of them stay to join or open practices.

Increasing the number of residency slots for physicians educated in California will keep those physicians in the state and can provide immediate relief for newly insured patients looking for quality medical care as the Affordable Care Act goes into effect.

In addition to residency slots, California needs more medical schools.

In August of this year, the University of California, Riverside, will open the doors of its full-time medical school. Originally started as a biomedical sciences program, students previously would begin their medical education at Riverside and complete training at the UCLA Geffen School of Medicine. With a broad base of support, UC Riverside was able to expand its program and will now be a four-year medical training program of its own. However, to stay operational, the school will need to secure additional funding, which AB 27 (Medina) and SB 21 (Roth) aim to achieve.

The Affordable Care Act has offered a chance for the medical community to be innovative and groundbreaking in the way health care is delivered to patients. We must seize this opportunity to show that integrated care led by a physician is not only the safest but the most efficient and cost-effective way to make the ACA a success.

Paul R. Phinney, M.D., is the president of the California Medical Association and a practicing pediatrician in Sacramento.

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