Why is the US healthcare system so full of "mini-doctors"?

[Lvdovicvs.Angelvs]

Hello. My name's Luis Angel, and I'm a clinical laboratory technician student here in Mexico.

My question is: why is the US healthcare system full of "mini-doctors"? like nurse practitioners, physician assistants, I could even include EMT-Paramedics, and such. In Mexico, this is a foreign concept.

As I said before, I'm a CLT student. Although we have reviewed what an arterial puncture is, we have been warned that that procedure is done usually by doctors. And although we review signs and symptoms of the diseases, the teacher has told us that they have removed treatment from the syllabus, because some started to treat people. We review signs and symptoms because the teachers keep in mind that most of us (not me) want to enter to medical school.

And I'm sorry if I offend anyone, but, to me, the "mini-doctors" model looks like laziness, doing more studying less. But I'm unfamiliar with the system so I don't know.

Your answers are appreciated

Greetings.

[blondy2061h, MSN, RN]

Many people give themselves or family members IM injections at home with maybe an hour of training max.

[chrisrn24]

Sure, properly trained anyone can give an injection. It is not a high level skill. Why do you ask?

Exactly.

Most "skills" can be trained. It's sharp assessment skills and a good eye that develop over time.

[BlueDevil,DNP, DNP, RN]

I have a patient who's family is administering his chemotherapy at home. I don't think they can read above a 5th grade level, but they are doing something I was never permitted to do because I lacked the necessary certifications, lol. Just because we don't allow people to do things inside the system doesn't mean they couldn't be taught to do it perfectly safely. It isn't necessary to have a Dana Faber Oncology Fellow hook up one's chemo. If I needed it, I would like to consult a Dana Faber Oncology team for my treatment plan, but I think I'd just assume be at home and let my partner hook it up and puke in my own toilet, all other things being equal.

I'm not sure what point you are driving at, Lvdovicvs.

[RNsRWe, ASN, RN]

I smell bait being dangled.

[RoseRyan]

There is no way on Gods green earth that this question could be serious

[OCRN3]

I am not familiar with Mexicos standards for doctors but I know a bit about central and South America. It seems like physicians in these Latin American countries are trained much more then those in the US. I was treated in a South American hospital where the MD started my IV and even had me sign consents. I had a nurse too who brought me meds and water, but I was confused why the doctor was doing RN work. I also found out there is no such thing as a ADN nurse there they only have BSN nurses. So maybe it's possible to have overly trained doctors that do ALL the work and use nurses as only assistants, while in the US all the other healthcare professionals aside from MDs, have specialized training in a very specific area. I think this benefits patients with so many checks and balances. Sure the NP or RN or RT does not have All the training the MD has, but does have specific training in an area where they can help the doctor. At the end of the day the MD has the last say. Most states still don't allow NP to be fully independent, and PA are assistants to the MD even though they do prescribe. I don't see any of these health professionals as mini doctors. NPs, who are the closet thing to an MD still looks at a patient through a nursing model primarily over the medical model. Just my opinion.

Sent from my iPhone using allnurses.com

[NRSKarenRN, BSN, RN]

Nurse Practitioners - Bureau of Labor Statistics

Diagnose and treat acute, episodic, or chronic illness, independently or as part of a healthcare team. May focus on health promotion and disease prevention. May order, perform, or interpret diagnostic tests such as lab work and x rays. May prescribe medication. Must be registered nurses who have specialized graduate education.

EMTs and Paramedics - Bureau of Labor Statistics

Emergency medical technicians (EMTs) and paramedics care for the sick or injured in emergency medical settings. People’s lives often depend on their quick reaction and competent care. EMTs and paramedics respond to emergency calls, performing medical services and transporting patients to medical facilities.

Physicians and Surgeons - Bureau of Labor Statistics

Physicians and surgeons diagnose and treat injuries and illnesses in patients. Physicians examine patients, take medical histories, prescribe medications, and order, perform, and interpret diagnostic tests. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.

• Over lifetime, PCPs can make $2.8M less than specialists
  
  September 21, 2012
  Daily Briefing
  The average primary care physician will earn up to $2.8 million less than a specialist over his or her lifetime, and payment reform is needed to correct the imbalance and address the nation's growing PCP shortage, University of California-Davis researchers say.
  

Various levels of practitioners needed to provide care to our US citizens, especially as less physicians providing primary care/family medicine, often due to low salary and lack of interest in "same old" diseases frequently treated.

[Lvdovicvs.Angelvs]

@OCRN3, @NRSKarenRN: Thanks for your answers.

What I was referring to CNAs giving IMs, I was referring to inside the system Expanding the scope of practice of the CNA. I was expecting some arguments like "that's different", but I messed it up.

The problem with the "everybody can do it" argument is that I can expand to a lot of fields. For example, the book "Where There is No Doctor" gives guidelines for treating common diseases, and even emergency treatment. It is expected to be used by the village health care worker. Does that mean anybody can be a PCP?

Again, thanks @OCRN3, @NRSKarenRN for not dismissing my question as trolling.

Greetings.

[BlueDevil,DNP, DNP, RN]

I anticipated as much and already addressed that point. Frankly, no, I wouldn't have a problem with properly trained CNAs giving the IM injections after being so directed by qualified personnel following their assessment of the patient. Someone decided that was redundant and it was more straight forward to just have that first individual, the qualified person doing the assessment and making the clinical judgement that said injection was appropriate (i.e. the Nurse) give the injection. It makes sense, rather than add an additional person to the mix, add time, cost and risk error. It isn't that your proposal is offensive or outrageous so much as it is impractical in an acute or subacute care setting.

In a clinic setting MAs give IM injections daily; I have not personally heard of an instance of a MA causing injury by improper administration. It has probably happened, but I don't know of any comparative analyses documenting the differences in outcomes between MA administered IM injections and RN administered IM injections. Would MDs administer better IM injections than either of those cohorts? Of course not. There would probably be no discernible difference between the groups, because it is not a high tech skill. The important factor is knowing when/if to administer, not how.

Is your question would I be willing to leave that determination (when/if) to MAs or CNAs as a whole? No, I would not. Nor, for instance, would I leave it to my daughter.

while she is a brilliant mathematician, probably smarter than most clinical providers, lol, she doesn't know anything about clinical decision making so it would be equally inappropriate to burden her with that responsibility (not to mention unsafe). It isn't a matter of laziness, or intelligence. It is about preparedness. CNAs are not prepared to make some judgements. We cannot extrapolate from this that all clinical judgements/decision making must be made by MDs.

I think all of this a moot point since you don't have NPs or PAs in your country, and it is working very well in ours. Beyond that, Karen kindly gave you a detailed answer to your original query. You seem to have a keen understanding of some very frequent debates regarding these issues for someone who has just barely heard of NPs/PAs and presumably has little to no understanding of American medical systems/culture. What a curious coincidence! I will interpret that to mean that we have more commonalities than we have differences between us.

[MunoRN, RN]

Correct me if I'm wrong, but it's my understanding that in Mexico a General Physician has completed a total of 4 years of school after school and one year of internship (and one year of community service). In the US after 4 years of post-high school education a Physician hasn't even yet started Medical school. So if your question is: why PA's and NP's do so many of the things that are only done by MD's in Mexico?, the answer is because NP's and PA's have more education than an MD in Mexico.

[Esme12, ASN, BSN, RN]

Since you are a student....I am curious ...is this for homework?

[JDZ344]

@BlueDevil,DNP: In Europe, the role that paramedics fill in America is filled by physicians. Some of them have to take extra courses before entering to the emergency service, but they are far more prepared than a paramedic.

@aachavez: I understand that all of them are prepared for their work. But, to me, some of those roles are disputable. Nurse practitioners and physician assistants, as far as I know, usually do what a doctor do. And I'm not sure about paramedics, but it is disputable if ALS is needed on the field.

Don't get me wrong. I probably messed it up when I said that it just seems like laziness, but it looks like the US is focused in create healthcare professionals at a fast rate, even if they're not doctors. Of course, I think that some people may find the duration of the education (that is minor than the duration of med school) attractive...

Greetings.

European here. (UK). Our paramedics are NOT physicians. They are highly trained professionals (spend 3 years at university), skilled in basic and advanced life support (after all, what is the point of resuscitating somebody in the street and then doing nothing else but bus them to the ED?), trauma management and a whole range of other things. Some of them even get advanced training to treat and discharge without transporting a patient to hospital. Takes a huge load off from our A&E system.

The nurses practitioners in our hospitals do not "do what doctors do". They do their own, distinct job role.