Low-cost extenders come at a high price

Street Smarts. By Scott Gottlieb, MD, AMNews contributor. May 14, 2001.

STREET SMARTS

A column looking at the corporate side of health care

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Last week, late at night, my 2-year-old nephew was stricken with the croup. My sister called her pediatrician, and a physician assistant called her back. He encouraged her to take my nephew into a steamy shower.

The next day, my sister called the doctor again. This time a nurse practitioner called in a prescription for prednisone. My nephew got better. He never saw a doctor.

These days, more patients are finding that a visit to the doctor may actually mean a visit to a nurse practitioner or a physician assistant. Most of this is due to financial reasons, because nurse practitioners and physician assistants are less expensive for medical practices.

Doctors can leverage their time, and boost their incomes, by managing a stable of "physician extenders" rather than seeing all patients individually. The idea is doctors would oversee nurse practitioners handling routine exams, freeing the physicians to focus on diagnostic dilemmas.

Economists and Wall Street analysts refer to this as the "industrialization" of medicine. Physicians can streamline their practices by delegating routine exams to cheaper professionals, economizing on their own costly services.

Such industrialization, economists say, is the logical next step for a system that has shifted from a healing art based on cradle-to-grave patient relationships to a fragmented, depersonalized delivery system driven by the pressure of medical economics and an increasingly cost-competitive insurance system.

In many ways, this was the promise of the practice management craze. These outfits aimed to bring modern managerial techniques into medical offices and apply the corporate fidelity to the daily routine. [...]