Sunday, March 22, 2009

R-E-S-P-E-C-T.... (Part One)
Dustup over at Dr. Centor's about the age-old question: Do surgeons respect primary care?

In this he links to a post from the ACP advocate blog, in which the testimony of Dr. Preskitt, on behalf of the American College of Surgeons, is beaten about.

First the testimony:

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.

Then the response:
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 comments of both posts go back-and-forth between
"Most PAs and NPs can do about 90% of what I do"....

"Many simple Specialty care procedures can also be delivered by appropriately trained mid-level practitioners, in fact the CardioThoracic surgery PA in our hospital routinely puts in Chest Tubes and does many simple procedures, if that is the argument we wish to have we could each have counter points. Many cystoscopies, endoscopes, along with much else that occupies a surgeons time can be done by technically adept nursing staff with the appropriate training. In fact, they employ such a model in some European countries."

So I guess we will all be out of jobs soon. Yes simple primary care can be handled by midlevel providers and yes portions of major procedures as well as minor procedures can be done by midlevel providers as well. But what of the other 10 percent? What if a complication occurs? What then?

I do respect primary care, they do an excellent job of managing chronic and acute medical problems.

The next post will discuss some of the reasons why we can't get along.

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