Akst: A nurse practitioner will see you now

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I'm blessed with healthy kids, so whenever my wife wants to take them to the doctor, I suggest we just mail a check to the pediatrician's office and keep the boys at home.

Why so cavalier? Because they rarely have any ailment worth treating -- or worth the risk from all the germs at the doctor's office. Our fine pediatrician went to Yale Medical School, and for years all we've brought her (thank God) are the sniffles.

I doubt society can afford this sort of thing much longer. The truth is, an enormous amount of health care is routine, and it's being delivered by people who are expensively overqualified. That's one reason too many people can't afford any care at all.


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In the future, expect a lot more care to be provided by perfectly capable people with less training, but perhaps more time. I'm talking about nurse practitioners, physician assistants, dental hygienists and other licensed health professionals who can easily handle a lot of routine medical matters.

We're already moving in this direction, and we'll have to move faster. Under President Barack Obama's health care reforms, perhaps a million additional New Yorkers will gain access to the health care system in 2014. We don't have enough physicians to accommodate all of them, and we can't produce a lot of new MDs overnight.

Even in the absence of these federal reforms, medical demand has been growing. Across the country, an aging population is using more care at the same time doctors are getting older and more women have entered the profession. Both groups tend to work fewer hours than young men. The Association of American Medical Colleges estimates we'll be short 90,000 physicians in 10 years.

Physicians and dentists, moreover, aren't eager to move to rural areas. Nurse practitioners and the like can help fill this vacuum, providing basic care and, when a case requires more expertise, referral to a doctor in a larger community.

Already, many states are moving toward allowing such practitioners to do more on their own. Seventeen states have opted out of a federal requirement that nurse anesthetists be supervised by a physician. In Colorado, controversy over this issue has ended up in the courts.

People worry about whether practitioners without medical degrees can provide equivalent care. But they're already doing so all over the country, thanks in part to serious training requirements and state regulation. Nurse practitioners, for example, typically have a master's degree as well as clinical training. They can meet most of the medical needs of the average patient, including prescribing medication.

Besides, it's important to measure any shortcomings these newer medical professionals may have against the shortcomings of a system that makes physicians so harried, scarce and expensive.

Which brings us back to health care costs. In the United States, they're just completely out of line; if we spent what similar countries do as a percent of gross domestic product, we'd save about $1 trillion a year. Moving away from an over-reliance on physicians and dentists can help rein in medical spending.

Consider nurse anesthetists again. Their median pay is $157,010, according to salary.com. That's a lot, but anesthesiologists make more than twice as much.

These trends might reverse themselves. We might yet produce a lot more primary care doctors and pay them a lot less. But I doubt it. Like it or not, there's probably a nurse practitioner or similar pro in your health care future -- and chances are, you'll be better off for it.Daniel Akst is a member of the Newsday editorial board.

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