Speaking of reform: ‘Not every ailment demands Dr. McDreamy’

Mike Riggs Contributor
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Last week various outlets began breathlessly reporting that the looming doctor shortage–a byproduct of the health-care bill’s subsidies–means ” you may soon call your nurse ‘doctor.'” I think this is supposed to be scary, or mind-boggling, but I’m not sure. Time and again, the possibility that nurses could have more autonomy in doling out medical care is, well, demonized by journalists. Why? In part because nurses don’t get to wear grownup clothes. But also because medical lobbies like the American Medical Association and the American Dental Association promulgate a false view that almost a decade of schooling is necessary to administer a vaccine, perform a routine checkup, or set a broken bone.

Well, enough of that writes Steve Chapman:

What people with medical problems need is medical care, but you don’t always need a physician to get treatment. You might also see a different sort of trained professional—say, a nurse practitioner, physician’s assistant, nurse, or physical therapist.

Not every ailment demands Dr. McDreamy, any more than every car trip requires a Lexus. If you have a sore throat, earache, or runny nose, you probably don’t absolutely require a board-certified internist to conduct an exam and dispense a remedy.

Private enterprise is already responding to what consumers want. Walgreens, for example, has established more than 700 retail health clinics staffed by nurses, nurse practitioners, and other non-doctor professionals. CVS has its own version. The number of these facilities is expected to soar in the next few years.

You might fear that this sort of treatment is inferior to what you’d get from your personal doctor. Your doctor might agree. The American Medical Association, reports the Associated Press, warns that “a doctor shortage is no reason to put nurses in charge and endanger patients.”

But put your mind at ease. A 2000 study published in the Journal of the American Medical Association found that where nurse practitioners have full latitude to do their jobs, their patients did just as well as patients sent to physicians. Other research confirms that finding, while noting that retail clinics provide their services for far less money than doctors’ offices and emergency rooms.

Notice the AMA reference? It’s complete and utter bullshit. In 2008, after the ADA was revealed to be blocking dental care in Alaskan tribes, I made a similar argument:

Some 60,000 indigenous Alaskans living in villages accessible only by plane, boat, or snowmobile received little dental care until the Alaskan Native Tribal Health Consortium decided to break a few rules. Following a model that is popular in Canada, England, Australia, New Zealand, and 42 other countries, the consortium sent tribal members to an accredited two-year dental program in New Zealand, where they learned how to fill cavities and clean and pull teeth.

The consortium spent over a year battling the ADA and the Alaskan Dental Society for the right to send dental therapists into tribal areas. Alaska’s Superior Court ruled in favor of the tribes in June 2007, allowing the therapists to continue their work, but only in indigenous communities. In light of the ruling, the ADA altered its strategy and decided to support the tribes’ efforts until it could send enough licensed dentists into remote tribal regions to render the therapists unnecessary.

The case received little national attention until the New York Times’ Alex Berenson wrote in April that “dentists in private practice consider therapists low-cost competition” because they are only paid “one-half to one-third” as much as licensed dentists. Current ADA President Mark J. Feldman responded a month later in a letter to the Times, denying that the ADA objected to the Consortium’s “experiments” out of its own “financial self-interest.”

Yet the ADA’s actions toward the University of Washington School of Dentistry, which backed the consortium, supports the financial self-interest angle. According to a story in the Seattle Post-Intelligencer, the Washington branch of the ADA “intimidated university officials by threatening to block donations by their members” until the dentistry school withdrew its support for the consortium and abandoned its plans to cosponsor, along with the medical school, a dental therapy track in its physician’s assistant program.

This wasn’t the only time the ADA has attempted to block a newcomer to the dental market. In December 2007, another New York Times reporter, Ian Urbina, wrote about the work of denturists. Denturists develop and install dentures and replace teeth; their inexpensive services are changing lives for the better in Kentucky, where residents, like indigenous Alaskans, suffer from tooth decay at a rate that is much higher than the national average.

Since then, the ADA has combated denturists by attempting to block their access to supplies. The agency openly discourages manufacturers of dental equipment from selling products to unlicensed dental practitioners, the only exception being dentistry students enrolled in ADA-approved schools.

According to the association and other opponents of alternative dentistry, dental work done by anyone other than a licensed dentist equates to “substandard care,” but their argument suffers when international comparisons are taken into account. Canada, for instance, created a regulatory board for dental therapy in 1974. The Australian goverment permits it as well, calling it dental prosthetics. In 1984, the United Kingdom amended its dentistry laws to make room for several types of alternative dentistry, among them the British equivalents to both denturism and dental therapy. And according to the Seattle Post-Intelligencer, some studies have shown that graduates of dental therapy programs “are better trained to provide care to children than dentists are.”