• Rich Barlow

    Senior Writer

    Photo: Headshot of Rich Barlow, an older white man with dark grey hair and wearing a grey shirt and grey-blue blazer, smiles and poses in front of a dark grey backdrop.

    Rich Barlow is a senior writer at BU Today and Bostonia magazine. Perhaps the only native of Trenton, N.J., who will volunteer his birthplace without police interrogation, he graduated from Dartmouth College, spent 20 years as a small-town newspaper reporter, and is a former Boston Globe religion columnist, book reviewer, and occasional op-ed contributor. Profile

Comments & Discussion

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There are 15 comments on What Happens if We Run Out of Doctors?

  1. Medicine is under assault from all fronts including it appears the good Dr. Davidson who feels Dr. Nurse can replace a primary care physician. And one wonders why people don’t go into primary care?

  2. I think a good question to ask ourselves is this: Is MD training necessary to complete the role of a primary care provider? If advanced care nurses or PAs (pending changes in state practice acts) know what is within their scope and when to refer to a specialist, what is wrong with that? I have often wondered if MDs are over-trained for being Primary Care Providers. To substantiate these thoughts, we would need to look at a lot of data (i.e. what are the primary diagnoses seen in the primary care environment, are there differences between referral patterns between NPs and MDs, are there tx differences between MDs and NPs, etc). What do other people think? Do you know if any such studies exist?

    1. Great question. There was a Cochrane Review along touched on those subjects called “Substitution of Doctors by Nurses in Primary Care,” but at the time it was done only 25 studies out of 4253 met the inclusion criteria to be included in the review. Thus, the authors’ conclusion was, “In primary care, it appears that appropriately trained nurses can produce as high quality care and achieve as good health outcomes for patients as doctors. However, the research available is quite limited.”

      Citation: Substitution of doctors by nurses in primary care, Miranda Laurant, David Reeves, Rosella Hermens, Jose Braspenning, Richard Grol and Bonnie Sibbald. DOI: 10.1002/14651858.CD001271.pub2

      Objectives of review: “Our aim was to evaluate the impact of doctor-nurse substitution in primary care on patient outcomes, process of care, and resource utilisation including cost. Patient outcomes included: morbidity; mortality; satisfaction; compliance; and preference. Process of care outcomes included: practitioner adherence to clinical guidelines; standards or quality of care; and practitioner health care activity (e.g. provision of advice). Resource utilisation was assessed by: frequency and length of consultations; return visits; prescriptions; tests and investigations; referral to other services; and direct or indirect costs.”

  3. Well, a few things will need be changed before this problem is solved.

    1. Policies in medicine need to be streamlined and the fear of malpractice and over-complexity coupled with under-payment needs to be eased. As a med student, I fear going into family practice because there are 10 ways to solve each problem but 5 ways are not effective, 2 ways are very risky, 1 way is very expensive and the last way isn’t really documented/supported by regulations or insurance.

    2. Compensation needs to be inline with what other specialities make. As a radiologist, if I can make 4x the salary with other benefits, why should I go into family medicine.

    3. Better support of existing family residents or newly trained docs. These people undertook the same loans and had the same opportunity cost as their peers who chose to go into surgery or rads or another field and are driving better cars, living in better places and can spend $$$ on luxuries that these people cannot afford. Does this sound like social justice?

    It’s easy to import doctors because their opportunity costs is different, often much less, and they really don’t care/understand the complexity. But there is no free cake here – you will have to deal with shortages tomorrow, or day after, until the underlying problem is solved.

  4. automation – skype exam with robotic triage. direct KNOWN insured-member diagnosis depending on severity of problem intervention moves to next level [possible human interaction. 80 percent of the health care is routine and almost predictable by CDC.

  5. “Only people with heart problems need cardiologists. Everyone needs a primary care physician.”
    So you would think that PCPs might make more. Interesting…

    1. Well, I can see how you would think that. But if PCPs are getting more patients, they can (and do) charge less per visit. Whereas a cardiologist, being a specialist, is only getting a handful of patients who have heart problems, and are providing more in depth diagnoses than a PCP would. So each visit costs a lot more, hence their increased salary.

  6. Respond to Student’s comment: I disagree with you. Doctors from China are just as competent as U.S. doctors because no matter what, med students still have to passed certain classes and exams. Also, I feel that Chinese students study way harder than Americans.

  7. I like the idea of nurse practitioners becoming primary care doctors. Whenever I have had the chance to interaction with RNs I’ve been impressed with their capabilities, e.g., during pregnancy. This is a win for everyone, form nurses, to doctors, to all who use primary care.

  8. If you want more US jobs, give those jobs to Americans ho want to be Primary Care Doctors,that is what is wrong with us, we always want to strenghten another country with all our knowledge so they can benifit.

    Next time you go to your Primary Care doctor , don’t complain why he or she is taking so long to see you while you sit waiting 45-60 minutes on top exam table,
    they are doing 50 different things all at once.
    they are looking at your chart , while typing another patience medications,answering questions, stopped by other doctors, nurses and what ever else that is front of them.
    You can help by studying be to be a Primary Care doctor to help with the high demand.
    Don’t let Technology comsume your life so much that you might depend on those doctors for care.
    Ask the Haitian Earhquake suvivers how many doctors where there to help them through tough times during Earthquake in their country?

  9. There is a shortage of doctors but there is also a shortage of residencies too. I passed my step 3 but didn’t get single interview this year, applied only in family medicine, why? because I am a international graduate, program directors are so obssesed with scores that they don’t care if you are a US citizen or Resident. Another thing I don’t get it that why they have 75% as passing score, why don’t they have 85% as passing score as no body care about 75% . These egoist, stupid program directors are giving a way to nurse to take control over the doctors.

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