For years, experts have predicted a physician shortage, especially in the primary care fields. Little has been done to increase the number of physicians choosing to pursue these specialties or increase the number of doctors to fill the gap. Rather, some are calling for mid-level providers to step up and fill this deficiency. While mid-levels can greatly assist and are much-needed in primary care, they are still not physicians and will not fill the gap. While they can work unsupervised in some states, in others they can only work under a physician supervision.
Why Mid-Levels Will Not Fill The Primary Care Gap?
– Their training is different. They are educated and trained to be mid-levels, Doctors are educated and trained to be doctors. They are not interchangeable. They are a great asset, but they are not trained to be doctors and should not be used to replace doctors.
– Many patients prefer being treated by physicians. While I have nothing against a patient who would rather see a mid-level provider than me, the patient should have enough options to be able to choose who they would like to see. They should not be forced to be treated by a mid-level because there are just not any physicians available for them. And, in the final analysis, we are all working for good outcomes for the patients and helping them be their own advocates.
– Mid-levels are not as well as trained to treat high risk patients. Many people have stated that the increased number of mid-levels will result in doctors seeing the high risk patients. But, as the population ages, so does the number of high risk patients. There will be many more complicated patients resulting from increasing age, the rising incidence of obesity, diabetes mellitus and other chronic diseases. The number pf physicians needs to be increased to match these needs.
– Mid-levels still need to call on physicians when they have questions. While they can see and treat patients, in some states without supervision, they still need doctors available as back up. Doctors are already overwhelmed by the increasing number of patients and demands being placed on us. Not all of us have any time left to supervision the growing number of mid-levels now practicing.
While mid-levels can help ease the looming physician shortage, they are not going to fill the void. More doctors are still going to be needed. As more patients are being insured under the ACA, more doctors needs to be available. To provide the highest quality care, a team approach needs to be taken. Mid-levels provide a valuable service to medicine and are highly competent to treat many medical conditions. But, they still cannot replace doctors. As more and more patients become insured, as the patients age and more complex medical problems as seen, we are still going to need more physicians. Yet, the number of physicians being educated and trained has not increased very much in recent years. While an individual doctor may feel overwhelmed and overworked by the shortage, the true crisis is the lack of access. This will be felt most by the ones we are all trying to help: the patient.
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Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year. She is a blogger for Physician's Weekly and MedicalPractice Insider as well as a guest columnist for HIT Outcomes. She has had articles published in several other media outlets. She is on the medical advisory board of SERMO. Recently, she has authored the book, “Inside Our Broken Healthcare System” and "The War on Doctors". She has been interviewed in US News and on NBC Nightly News.
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