When I go to the doctor’s office, I usually see a registered nurse practitioner. She’s a family friend, and frankly, damn good at her job. Since I’m healthy (and clearly in amazing shape), this is almost always better than seeing an actual doctor. The same thing happens when I go to the “dentist.” She usually only shows up at the end, after the hard work of cleaning my filthy fangs is done by a dental hygienist. The dentist shows up late, prods around a bit in there, tells me to floss more, and is on her way.
But what if I needed surgery? Then, I would certainly hope that someone highly-trained and certified (yes, some regulations are good!) would be doing the cutting (be that with a scalpel or a laser). But, increasingly, that’s not as clear-cut (pun intended) as it used to be.
An inchoate phenomenon — spurred by a shortage of doctors and an increased lobbying campaign by groups of other medical professionals — has blurred the lines between doctors and other medical professionals. We’ve seen examples of nurses earning their doctorates, and then started to refer to themselves “doctors.” And we have seen recent examples of state sanctioned conflation of optometrists and ophthalmologists.
This is potentially dangerous. For example, a few years ago, “A Veterans Administration probe found that eight veterans at a Northern California VA facility suffered potentially-preventable vision loss while under the care of optometrists, according to the Associated Press.”
Worries that this sort of thing would spread prompted physician Ford Vox to write this for the Atlantic,
If you need laser eye surgery in the state of Kentucky, or a little cosmetic work around the eyelids, it now behooves you to ask your prospective surgeon the following question before signing the operative consent form:”Say doc, did you go to medical school?”
Kentucky joined the company of Oklahoma last week as the second state to conflate optometrists and ophthalmologists. Only ophthalmologists are the sort of doctors who graduated from medical school, did an internship, completed a three-year residency in eye surgery, possibly a fellowship after that, and have achieved and maintained national board certification through a program of lifelong learning in their specialty.
This general problem has only accelerated under ObamaCare. As CNS News reported, Under the Affordable Care Act, the Health and Human Services Department is spending billions of dollars to expand community health clinics, which are mainly staffed by nurse practitioners and physician assistants.”
Which brings us to the today. The Louisiana Legislature passed HB 1065 last week — which would allow optometrists to perform some surgical procedures currently reserved for ophthalmologists. Gov. Bobby Jindal can choose to veto it (though he appears to be disinclined to do so) or, otherwise, it will automatically become law.
So here’s the interesting political part. Jindal is clearly running for president, and it’s probably safe to assume that so is Kentucky Sen. Rand Paul — an opthalmologist who performed pro bono eye surgery as recently as last week.
Now, I’m not suggesting this issue will dominate the Republican primary contest. But for health care wonks out there, here’s hoping some intrepid reporter, or — better yet — a debate moderator poses a question to these two likely candidates about ObamaCare, the doctor shortage, and the degradation of health care. This could end up sparking an elevated and timely debate about the future of health care in America — and possibly cause us to re-evaluate our expectations regarding the standards of expertise and qualification we should expect from our surgeons before we go under the knife.
