A few years ago, I interviewed the President and CEO of our local hospital system about the future of medicine. It was the first interview for my Heroes in Healthcare blog. I had a scheduled 30 minutes of his time and recorded the entire conversation on the phone via my voice recording device. Unfortunately, just like my first podcast, the audio disappeared and the few notes I had taken were lost in a move later that month.
Many of you know this doctor if you have lived or worked in Central Texas. Some have had the honor of being his patient or working along side him in the ER or clinic. He’s is incredibly skilled in the art of medicine, treats patients like his loved ones and has some of the most calming energy even in the face of emergencies. I remember one of my first days in clinic, I called him about a patient who came in with symptomatic atrial fibrillation. The paramedics were there, but they needed an order from me to treat her a. fib. I was in complete panic mode and couldn’t even begin to think of the Advanced Cardiac Life Support algorithm. After encouraging me to take a deep breath, he calmly walked me through the steps, we stabilized the patient and she went on her way with EMS. I will forever be grateful for his patience and calm through this situation and for not making me feel like a total dummy.
During our interview, we talked about how he missed his clinical practice, but felt the need to address the healthcare crisis from a different position. I also asked him where he thought medicine was headed. He told me that the frontline of medicine, the primary care providers of the future were not going to be doctors or even Physician Assistants or Nurse Practitioners, but specially trained medical assistants, community health workers, promotoras who learned about specific chronic conditions and delivered education, tools, resources and lifestyle changes outside of the clinic environment. Then if the patient needed drugs or labs or treatment, then the MD/PA/NP would take over.
I completely agree with him. I think in five to ten years, PAs and NPs will be the primary care providers and the MDs/DOs will be the specialists. This isn’t news, this has been the prevailing thought on advanced practice providers for a couple of decades now. Then in twenty to thirty years, the medical assistants, promotoras and community health workers will take over.
So why even spend your money to go to PA school or NP school? Because we’re living in today and the certification and the alphabet soup behind our name gives us credibility and legitimacy. Because in order for state medical boards and rule makers, doctors, associations to trust that we’re capable of being sources for change and responsible colleagues, we need to learn along side them in school and graduate with rigorous training. Plus it’s pretty awesome to go to PA school, especially if you’ve loved science and learning as much I have. You get to learn from leading minds in pathology, A&P, pharmacology, endocrinology, neurology and every other ology. Then you go on rotations under doctors who teach you various tricks of the trade and about the craft and art of medicine. And most importantly, you find your tribe in school. The like-minded community, your family and partners in crime, your two a.m. study buddies and competition in cartwheel contests when you need an energy boost. They make it all worth it.
Oh and your patients, they’re the main reason you should go to PA or NP school. They deserve to be treated by someone who goes into medicine for the service and not the money or prestige. We’re are the ones who are slowly shifting the paradigm away from factory medicine into a whole health model.
There are doctors who do this too, but they’re often forced into the conveyor belt of primary care and have less opportunity and time with patients. There are some trailblazing doctors who have carved a new system with direct primary care and membership-based practices. This is not to say that there aren’t amazing doctors out there, there are so many, I work with many of them. But they’re part of this broken system and often feel stuck and hopeless, I know because I talk to them often about this and that is what they tell me. To them, I applaud your commitment and persistence to the craft. I wish you for you to be empowered to take the control back from insurance companies and administrators and realize that you’re a scarce resource and actually have the biggest influence in helping change the system.v
So that’s my two-cents. I’m excited about the future for PA’s and NP’s. I love my profession and even though I am practicing clinical medicine less and less these days, I will always encourage folks to go the PA route. But I’m even more excited about having a community health worker or promotora at the end of each city block to attend to the needs of our increasingly chronically ill population. What do you think?
Photo from Ambro at http://www.freedigitalphotos.net/images/agree-terms.php?id=100103840