Rage, Rage Against the Dying of the Night

Students of poetry probably wouldn’t apply that line to this subject, but, what the heck, here goes.

I thought of Dylan Thomas’ poem when I read that Bob Deweese and David Watkins (Henderson) both voted against House Bill 556. (See CJ Headline: Bill to expand nurse practitioner duties advances).

Watkins, 67, a cardiologist and DeWeese, 76, a retired general surgeon must both be unaware of the two converging mega-trends that argue for the expanded use of physician extenders – Nurse Practitioners (NP) and Physician Assistants (PA). I am guessing they both belong to the “fellowship of the miserable” who want things to go back to the way they were in the golden era of medicine.

Whenever that was.

Baby Boomers started turning 65 this year. Over the next twenty years, there will be more and more older Americans. Further, Kentucky’s population will be older than the rest of the Country. The older the population, the greater the demand for primary care services.

Which leads us to the second mega-trend. There will be proportionally fewer young people. That means fewer professionals. Fewer lawyers, accountants, engineers and yes, doctors. And, the scarcity of doctors will be even more acute in the specialities of family, internal, obstetrical and pediatric medicine because of lifestyle desires and relatively low incomes (as compared to a neurosurgeon for example). That means fewer doctors to take care of patients, over and under 65 years of age.

So who will take care of these people?

Like the entire health care “system”, the solution is multi-faceted and complex. But most professionals, including many primary care physicians, agree that one part of the answer is the expanded use of nurse practitioners and physician assistants. And, to effectively use NPs and PAs, Kentucky’s antiquated laws need to be changed to allow this to happen.

DeWeese and Watkins, joined by the Kentucky Medical Association,  justify their opposition on the grounds that patient care will suffer. That’s hogwash of course. Both NPs and PAs have to meet licensure requirements and the Commonwealth can strengthen those requirements, including the level of physician supervision, if it is required and if the political will exists (always a question).

In the immortal words of another Dylan, “the times, they are a changing.” It’s time for the medical community, including the KMA, to wake up and smell the coffee. The fact is that patient care will suffer if we don’t take steps to increase the supply and use of physician extenders!

Someday, maybe, we’ll have some representatives in our legislature that will look past next week when considering public policy.

Yeah right.

At least they will get dueling out of their oath of office.

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