I’m old enough to remember when a doc took two dollars to see you in his office, and the entire staff was his wife (when I became a doctor, only 6 percent of docs were women, so yes, the doc was a “he).

In the 1980’s, I had one secretary, one nurse.and a part time typist to help me.

In 2000 I worked for the government, and we had three nurses for two doctors (and yet often I was left trying to find one to help me…this was a government clinic, after all, so coffee breaks tended to be long). Then we had 6 folks in medical records, and another four in the office doing billing and whatever. We had one secretary full time whose only work was to “prioritize” who got care and try to find someone to see the patient cheaply (only a few docs would see our patients because the IHS payed poorly, so often the wait was long…and often patients missed appointments).

I frequently felt that the priorities of the “office” wasn’t quite the same as the patients or docs.

I actually went to a meeting where a supervisor from the area office told us our duty was to treat patients within budgetary restraints. I corrected her and said the US Government promised the tribes free medical care in exchange for stealing their land, and that our original mission statement was to give medical care to Native Americans, and if the money wasn’t there, to treat them anyway. Ah, of course, she said. But within budgetary restraints.

Well, I’m retired and don’t have to fight a government bureaucracy every day to get decent care for my patients.

So why not go into private practice? Because starting about 20 years ago, big business took over medicine, and I’d rather fight Uncle Sam than the front office of an HMO.

But now, even docs in private practice may find the bureaucracy is coming…

Item One:

Commission Is Likely to Set Nation’s Health Workforce Policies, Say Experts

Sounds benign, doesn’t it?

Translation: They will decide who works where and what they will do.

Then there is this:

Unlike similar advisory committees, the National Health Care Workforce Commission will evaluate and make recommendations for the nation’s entire health care workforce, giving it a broad perspective and scope.(italics  mine).

What’s wrong with this picture?

This means the Federal government, ( who values correct paper work over patients) now plans to tell docs how to practice, where to practice, and the hell with you if you object.

According to AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, the current response to the nation’s health care needs is “reactive and totally market driven.”

No, no market forces allowed, folks. We’re all socialists now.

Establishing the workforce commission will give officials and other stakeholders an opportunity to better align resource use with creating an adequate workforce, he said.

Who are “other stakeholders”? You mean the patients, or the docs? I’ll believe that when I see it.

Because after years with the Feds working with the Indian tribes input to improve medical care, the dirty little secret is that the best hospitals and clinics on the reservation are those where the tribe took them over, removing Federal control. (usually using casino profits to buy much needed equipment, hire more staff, or replace the aging buildings).

But this “top down” supervision is masked by pretending that local folks will get together and attend mandatory government meetings to think about the problem and devise solutions. by making it a community effort:

“The commission will help the country as a whole start to think about the workforce that we need for the future instead of the workforce we have for the present,” said Epperly.


Put in weekly planner: Spend hour 9 to ten pm Wednesday thinking about workplace problems.  The commission is there to “help the country as a whole” to think correctly about such things.

What gobblygook. And this is from my so called academy, which uses my hard earned money to write such drivel and ignore my own ideas on how to run an office based on thirty years in rural underserved areas.

The “good” part is that they might get around to paying rural overworked docs more.
But the bad news is that they think making a big commission is the answer to everything.

An easier way would be pay bonuses to rural docs, or start reimbursing them at a higher rate than docs who practice fewer hours in areas with money and lots of physicians, such as the suburbs.

They also might want to subsidize the local hospital for equipment instead of shutting it down in the name of efficiency. You still might have trouble recruiting, but loan reimbursement for rural work might lead to more docs in rural areas. And don’t overlook the FMG’s: Need a doc? Just come here to the Philippines and say if you work there you’ll get a green card for you and your family, plus a guaranteed income, and voila, instant physicians.

But of course, the commission is not just about telling docs where to practice, but saving money.

And they pull a slight of hand here: The idea is to convince folks that a physician assistant (4 years training) or a nurse practitioner (6 years training) is just as good as a doc (11 years training), and therefore should be allowed to make medical decisions without the bother of a physician supervisor.

There is a great deal of controversy about whether nurse practitioners in Medicare should be able to write prescriptions to admit patients to hospice, said Patel, citing an example.

I’ve worked with both physician assistants and nurse practitioners, and they give excellent care, especially for chronic patients that need a lot of educating, but when it comes to diagnosis of an unknown illness, they tend to lack depth of knowledge, (i.e. use lists and “scientific” algorithms or check lists to decide what’s wrong, instead of the art of medicine, which often detects small things not on the list, that points to the diagnosis behind the patient’s problems).

But the most ominous part of the article is this:

The workforce commission will be able to work through these types of “sticky issues that are way too political for Congress to legislate,” said Patel.

Translation: Can’t let the common people have a say this via their elected representatives.

L’État, c’est moi


Nancy Reyes is a retired physician living in the Philippines. She blogs at HeyDoc xanga blog.

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