Doctor, nurse roles considered as shortages take hold

"The private doctor's practice — long considered a mainstay of American medicine — could be going the way of the independent bookstore and locally owned pharmacy," The Detroit News reports. "Crushed by mounting economic pressures, more midcareer physicians in Michigan and across the country are giving up their solo practices and joining large and better-financed hospital systems as salaried employees. And an increasing number of young doctors graduating from medical school are forgoing private practice in favor of hospital jobs with steady paychecks and regular hours. … The shift is ushering in a new era in medicine that improves the coordination of patient care between doctors and hospitals and further consolidates the health care industry. But it also means the steady demise of a venerable tradition: the autonomous doctor" (Rogers, 7/20).

As doctors join hospitals and shun private practice, primary care doctors are also getting harder to find, The Boston Globe reports. "Massachusetts has the highest ratio of doctors per population in the country, but that doesn't mean its residents can find a primary care physician who is accepting new patients. It got harder to secure a slot after 2006, according to one of three reports on health care released by the state today." Only 60 percent of doctors practicing family medicine were accepting patients in 2009, according to the Massachusetts Division of Health Care Finance and Policy. "Last year only 44 percent of internal medicine practices were accepting new patients, down from 66 percent in 2005." Fewer residents there don't already have a primary care doctor, however — only 11 percent in 2008 don't (Cooney, 7/19).

In the meantime, nurses are also coming under greater scrutiny. ProPublica has a story and list regarding discipline actions taken with nurses in locations across the country. "Each state has a different process for investigating and disciplining nurses and for making licensing information available to the public." ProPublica has charts that allow the public to verify a nurse's license and has stories about the practice of allowing nurses who are sometimes allowed to practice in one state though they were disciplined in another because of a multi-state agreement allowing them greater practice mobility (Ornstein and Weber, 7/20).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.