3. A different level of care implemented by profit seekers.

By this time, you may be asking what about the word “PROVIDER” mentioned in the title of this article. Let’s talk about it. What is a provider? It is a person that supplies someone with “something”. Even if that something is of different quality!!  Well, because of all the yearly cuts in payments and the need to see more and more patients, the creation of a cheaper employee other than a doctor had to take place.  This was done by both hospitals and insurance companies and also some physicians, with the help of our legislators in Washington and “political” medical professionals in the AMA and State Medical Societies. What did they come up with? You have probably heard of “Physician Assistants”, and “Advanced Practice Nurse Practitioner”, the so-called midlevel. Well, these individuals have been granted the authority to practice medicine without going to medical school, plain and simple! Nurse practitioners are the fastest growing primary care so-called “clinician” and are more likely to provide care for underserved populations and at times the sickest. The likelihood of being seen by a nurse practitioner or physician assistant was greatest among patients who were lower income, rural residents, and people with disabilities. Nurse practitioners and physician assistants are increasingly involved in care of older patients who usually are the least healthy in nursing facilities. This is crazy!  

Are these so called “providers” an asset to medicine? Yes, they are most definitely, but they should never work unsupervised plain and simple. They did not go to medical school and did not pass the rigorous exams that MD or DO have to pass and neither did they undergo four or five years of supervised training after getting their degree of APRN or PA. I have seen nurses doing desk work at the hospital or at doctors’ offices becoming “Advance Practice Register Nurse” (APRN) and getting their DEA number and start seeing patients. No training no nothing.

Presently they have included these mid-level practitioners together with MD and DO under the umbrella name of “PROVIDERS” as if they were equal. No, they are not equal by any means! The worst part is that they can now work independently and unsupervised just like a physician! They have become very utilized in big hospital practices because not only are they cheaper to hire but also because they are known to practice shotgun medicine because of their shallow knowledge and order many tests which insurances pay. This brings in lots of money to the hospital or group. The only one who suffers is the poor patient that is seen and treated by one of these individuals without supervision. From 2013 to 2019 the share of U.S. health care visits delivered by non-physicians such as nurse practitioners or physician assistants increased from 14 to 26 percent. And this is only going to go up

All of the issues above mentioned, is what is driving real physicians away from medicine. Unfortunately, they have turned the most noble profession into a business and into a high stress rat race where patients are seen at a mile a minute and many times not by a real physician. Who is to blame in my view? Health insurance company executives and hospital executives!

Medicare payments to physicians have been declining for two decades. In 2025, Medicare payments to physicians are projected to be cut by 2.83%, the fifth year in a row of cuts. This adds up to 14.1% in the last five years alone! This is on top of a 29% drop in payments since 2001. Both add up to 43.1% cuts since 2001 while expenses in everything have gone up astronomically like supplies, malpractice insurance, office space rentals etc. The cuts disproportionately affect small, rural, and independent practices And, at the same time, patients’ insurance premiums are going up! Then just ask yourself one question. Where is the money going?