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R-E-S-P-E-C-T Find out What It Means to Me

April 14, 2010

Some things are very easy to predict and one of them is that, with the introduction of ObamaCare, nurses will take over larger parts of medical doctors’ work. (Ever wondered why the American Nurses Association was so welcoming of ObamaCare?) That’s not necessarily a bad thing. In most cases of sickness, the French Cowboy would rather be in the hands of an experienced nurse than in those of an unexperienced doctor. And yet, no matter the disease, I’d rather be in the hands of an experienced doctor than in those of an experienced nurse.

This story by the AP mentions how nurses are regarded as second class primary care providers compared to doctors and how they resent the fact. Varying from state to state, nurses (as of now) are restricted by law in what they’re allowed to do for a patient, they generally receive less payment than doctors, and in some states aren’t allowed to call themselves “doctor” even when they hold a doctorate’s degree. Now if this sounds awfully unfair to you consider that there is a factual difference between a nurse’s education and that of a doctor. Getting paid less for (mostly) the same type of work when you have a lower degree than a colleague is standard in any business sector. And while a doctor’s deeper and broader understanding of things thanks to a longer and different education than a nurse may not necessarily show in his use of a syringe, it is likely to make a difference in his finding of diagnoses and therapies and in a way that justfies higher payment.

Nurses have a different specialisation than doctors. They’re closer to the patient and entrusted with the immediate needs, while a doctor has the greater responsibility of managing the patient’s long-term development. The nurse nurses, the doctor tries to heal. Those who observe that nurses do “the same job” as doctors but get paid less and conclude that this is unfair discrimination are missing this fundamental difference in the respective roles.

But let’s consider what will happen when nurses are elevated to the level of doctors. They will get the same payment as doctors (as the AP mentions, ObamaCare already does so for midwives), nurses will be allowed to call themselves “doctors” (anybody who has ever cared for an elderly patient and claims that this will not create confusion is either very dull or wilfully lying), and they will be allowed to do much more if not everything themselves without a doctor’s backup. Once that is so who needs “doctor doctors”?

Those who want to enter a medical career will prefer going the nurse’s route over the doctor’s because it’s shorter and (reasonable people may disagree) easier, but in the end you achieve the same status including the same paycheck. The loss will be felt not only in diagnoses and therapies, but also in scientific advancements. Fewer physicians will have both the experience and the knowledge needed for medical research.

One of the arguments in the AP story in favour of granting nurses the doctor status goes as follows:

Nurse practitioners’ uphill battle for respect makes them precise, accurate and careful, [Michelle Artz of the American Nurses Association] said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.

That may well be, but it won’t stay like this once nurses got their payment parity. There will be no more “uphill battle for respect”. If it is the allegedly unfair discrimination between nurses and doctors that makes nurses “precise, accurate and careful” then what will ensure their being so once they’re satisfied with the “respect” (read payment) they receive? The French Cowboy isn’t saying that nurses will be sloppy when paid as doctors. It is Mme Artz’ argument that is suggesting it.

As for the second part of the quote, that a nurse’s appointment is ten minutes longer than the doctors’, what accounts for the difference? And why would it stay this way once nurses and doctors are equalised in terms of pay, responsibilities and power? Even if nurses would be willing to spend more time with their patients out of the goodness of their hearts, with the predicted decrease of doctors offering care and the sure-to-come surge in demand for care thanks to the enactment of ObamaCare, it is unlikely that nurses will have the luxury to continue to be so generous with their time.

Having said all that, the shortage of doctors will necessitate an expanded role for nurses either way. When given more responsibilities, higher payment is in order. But the all-but-complete equalisation of nurses with doctors suggested by the American Nurses Association is a mistake. The fundamental problem here is, of course, the severing of consumption from costs. The rationing and price restrictions in the medical services sector already in place and to be expanded with ObamaCare stifle all signals about consumers’ preferences and service providers’ abilities. So it is no longer of relevance what the patients prefer, instead special interest groups (be it the American Nurses Association or organised doctors’ lobbying groups) receive favours according to politicians’ and bureaucrats’ inclinations.

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