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OP-ED: Right prescription for health care provider gap
May 03, 2013, 05:00 AM Los Angeles Daily News
Starting next year, nearly 5 million uninsured Californians will suddenly have health coverage, due to the implementation of the Affordable Care Act, or Obamacare.

Sounds great, right? But having insurance doesn’t guarantee Californians can actually get care — not if there is a shortage of caregivers.

That’s exactly the situation the state faces in 2014. Even now California doesn’t have enough primary care physicians. Forty-two of its 58 counties fall short of the federal government’s most basic standard.

The California Medical Association wants to build more medical schools and expand opportunities for young doctors. That’s a smart plan. But that’s not going to be much help to the millions who go looking for a doctor next year and can’t find one. Training a doctor takes a decade. That’s a long time for a patient to sit in a waiting room.

The chairman of the state Senate Health Committee, Sen. Ed Hernandez, D-West Covina, has a good idea to help bridge the gap.

A practicing optometrist, he wants to expand the ability of nurse practitioners and other professionals such as pharmacists and optometrists to help treat patients with primary care. Their work would be limited to what they’re already qualified to do but often not allowed to do. Changing the rules so that these health care professionals can provide direct service would make better use of their skills and provide at least some care for people who can’t find a doctor.

Seventeen other states, including Washington, Oregon and Colorado, have expanded the scope of nurse practitioners. Doctors predicted a surge in medical errors, but studies have not found this.

The Institutes of Medicine, the health arm of the National Academy of Sciences, has recommended for years that nurses should play a larger role in diagnosing and treating patients and in helping to manage chronic diseases.

California already has about 17,000 nurse practitioners. They can be trained more quickly than doctors and at considerably less expense.

Hernandez’s legislation, a package of three bills — SB 491, SB 492 and SB 493 — comes up for its first committee hearing Monday in the senate’s Business, Professions and Economic Development committee. It’s going to be a fight, because the CMA, which represents the state’s doctors, is opposed. The association will argue that patient safety will be compromised.

But nurse practitioners, pharmacists and optometrists would not be going beyond the bounds of their training.

The first bill, SB 491, would allow nurse practitioners to establish independent practices and deliver limited care without a doctor’s oversight. It’s not like nurse practitioners would be doing surgery, Hernandez said; they would be limited to primary care they do now.

This could prove especially helpful in rural areas, where primary care physicians are scarce.

The other two bills would allow optometrists to diagnose and treat diseases that show up in the eyes, such as diabetes and some cancers. They would also be able to do minor eye surgeries, if they’ve had the appropriate training. Pharmacists would be able to vaccinate children and, with additional training, prescribe or adjust prescriptions within the limitations of their expertise. Hernandez notes that with their four years of medical training, pharmacists are currently the most overtrained and underused health care professionals.

Another argument that will be used to thwart this legislation is that it will set up a two-tiered medical system. Hernandez says we already have a two-tiered health care system in which some people can access care and others can’t.

Ideally we would have enough primary care doctors to serve all current and potential patients and enough money to afford it. That’s not realistic, or even cost-efficient for the future. California has to be innovative in its use of medical professionals to serve newly insured patients.

Instead of fighting Hernandez’s bills, the doctors should work with him to build in safeguards so that all Californians can have reasonable access to health care.


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