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  • Dean Rohrer / NewsArt

  • Curren Price

  • Ed Hernandez

Viewpoints: Ease rules on who provides primary care? Yes

Yes, it would help with health care reform and state’s shortage of doctors

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

Chances are, if you've visited a hospital or a health clinic in recent years, you've received medical care from a nurse practitioner or a physician assistant. And if that's the case, then you've come face-to-face with one of the health care professionals who are essential to successfully implementing the Affordable Care Act in our state.

The reason you may have been treated by one of these professionals, rather than or in addition to a physician, is twofold. First, these health care providers are highly capable of providing care. Nurse practitioners, for example, have earned graduate degrees, undergone advanced training and qualified for rigorous certifications. They are qualified to diagnose common illnesses, make referrals to specialty doctors and prescribe medications.

The second reason you may have come in contact with one of these professionals is that they are desperately needed to fill the gap between an increasing patient population and overloaded general medicine physicians.

Let's put some numbers to that gap. The Association of American Medical Colleges says that, by the year 2020, the United States will face a shortage of 90,000 doctors. That's due in part to an aging population that also continues to grow, and also in part to medical schools unable to produce new doctors fast enough. In addition, physicians and other providers who are trained outside of the United States face unnecessary barriers preventing them from practicing here – barriers that need to be revisited. But mostly, that doctor shortage will be caused by the new health care law, which in January 2014 will immediately expand health insurance to approximately 30 million more Americans.

Those new patients will stampede into the health care delivery system – potentially 7 million of them here in California. Many may have not had health care for years. And when they get there, they'll meet doctors already strained by patient overload. Just last month, a study by Johns Hopkins University revealed that 40 percent of physicians in hospitals believe they have too many patients each month to safely take care of them.

A quarter said that their workload prevents them from adequately discussing treatment options with patients, and one in five admitted that patient workload has probably led to patient complications and even death.

That's where nurse practitioners, optometrists, pharmacists, physician assistants and others come in. They hold the ability to alleviate some of that pressure from physicians and to provide quality care to serve some of the incoming flood of new patients who will be covered through the Affordable Care Act. National health care organizations recommend that they do exactly that. These trained and trusted medical professionals will be required to fill the provider gap that is already occurring within our health care delivery system, and which will be exacerbated when the new health care law goes into full effect.

Physician assistants, nurse practitioners, pharmacists and optometrists have all significantly advanced their educational, testing and certification programs over the past decade. They've enhanced clinical training, moved to graduate or advanced degrees, and upgraded program accreditation processes. But California's practice acts have not kept pace. It begs the question: Why does California law tie the hands of these medical professionals?

Study after study has shown that nurse practitioners, for example, provide a high level of care. They're able to spend more time with patients than are physicians, and they do so at a lower cost. Patients cared for by nurse practitioners rather than physicians have been shown to more successfully achieve weight loss and reduce blood pressure, and they report better overall health statuses. These findings are particularly important when you consider that the new patients who will be covered through the Affordable Care Act are overwhelmingly low-income and Latino, and what they need most is routine preventive care.

The model of medical care that prevents highly trained health care practitioners from providing even the most basic care without strict oversight from a physician is outdated, and it ought to be changed urgently.

Simply put, there are not enough physicians in California to address the increased demand brought on by the Affordable Care Act. Doctors already acknowledge they are overloaded and that the quality of care is at risk even today, before 7 million currently uninsured Californians join the health care marketplace. If we are to prevent the quality of health care in our state from diminishing, it's clear that all highly trained medical professionals will play an important role.

Sen. Curren D. Price, D-Los Angeles, chairs the Senate Committee on Business, Professions and Economic Development. Sen. Ed Hernandez, D-West Covina, and an optometrist, chairs the Senate Committee on Health.

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