Bradley Flansbaum
Posted 3/13/12 on The Hospitalist Leader
Here is a twist of irony.
Physicians, and rightfully so, are called hypocrites, when on one hand they decry the payment system for inadequate reimbursements (and threaten patient access), while on the other, abhor solutions to remedy the same problem. Adoption of midlevels (NP’s and PA’s), which obviously are less costly, but also crowd out physicians and encroach on sacred turf is a prime example:
Representatives of the American Medical Association and the American Academy of Family Physicians said they agree with the need to expand the primary care work force. But they questioned the institute’s recommendation to expand APNs’ practice scope.
“Increasing the responsibility of nonphysician health care professionals beyond their education and training is not the answer to this shortage,”
However, a twist. Today in Connecticut the governor’s office is proposing to replace nurses – which by law are the only professionals allowed to dispense prescription medication in the field, with less expensive health aides. From a Connecticut’s home care trade association representative:
Wodatch says there are serious concerns on the minds of nurses and the agencies that hire them — from affordability to liability to figuring out which patients are best suited for the change.
She described the kind of patients who would benefit from still seeing a nurse every day: “One that has changes on a daily basis, one that may have outbursts, may have significant mood swings on any given day, not be safe with a home care aide who’s trained just in giving medications and not really recognizing symptoms, side effects, interventions that could be put in place to avoid further problems.“
I just might frame this on my wall.
Care And Cost 
When I was in grad school, we had to read The System of Professions by Abbott. If I remember correctly, he describes the professionalization of dentistry. How after a professional association is created, it continues to lend strength and build credence for itself by promoting a unique role as an expert for itself and grows the profession by growing its reach and influence. When dentistry did this first, people only ever saw the dentist if they had toothache. Then the ADA said preventive maintenance in the form of cleanings was important to avoid future, more acute issues. Once that became “normal”, the ADA recommended that twice a year would be ideal. Now that is normal. Professions like to corner expertise and tout themselves as the final authority in a particular domain so that no one else can gainsay them.
My point is this, physicians are scared of ceding control and influence to other not as highly trained colleagues because it may diminish their profession (it doesn’t but that is the perception). And what is sauce for the goose… The nurses are also reacting against a perceived diminishment (is that a word?) of their profession.