Why doctors' group is wrong about empowering nurse practitioners [CA]
OpEd with some valid points and some intriguing comparisons. However, supporting NPs doesn't (and shouldn't) have to be at the expense of physicians. Thoughts?
"A guild protects its own. Its goal, whether it's an association of medieval blacksmiths or of 21st century forensic accountants, is always the same: to keep its numbers low and its services expensive. Guilds have traditionally achieved this goal through "regulatory capture" — mandating an elaborate system of accreditation, for example, or requiring lengthy periods of apprenticeship.
The American Medical Assn., perhaps the most successful guild in American history, has done an exceptional job of serving its members. Notwithstanding a rough patch in the 1930s, when the Supreme Court found it guilty of violating the Sherman Antitrust Act, the AMA has held the line against socialized medicine (though it failed to stop Medicare), restricted the number of medical graduates and, until recently, fended off competition from the country's 205,000 nurse practitioners, who threaten to undercut doctors by providing cheaper care.
The strength of the AMA and state-level doctors' guilds can be measured in physician salaries, which are on average twice as large as in other advanced economies; and in American healthcare spending, which, as a fraction of the economy, is twice as high as the OECD average (despite lower rates of insurance coverage).
Doctors' guilds have been able to achieve so much because they have managed to convince the public that 'what's good for doctors is good for patients.' Is that really the case? We don't believe that 'what's good for prison guards is good for prisoners.' (And we're starting to doubt that 'what's good for teachers is good for students.') The enduring prestige of doctors over and above other professionals has been a persistent barrier to healthcare reform, a lesson Hillary Rodham Clinton learned in 1993 when the AMA helped torpedo HillaryCare."