Can you think of a really good caption for this medical cartoon? The winner will receive a Better Health t-shirt, effusive praise, and bragging rights. The winning caption will be chosen on the basis of subjective criteria by a panel of 3 judges of variable wit. List your captions in the comments section. Enjoy!
By Steve Simmons, MD
In order to solve the increasing shortage of primary care doctors many experts have proposed a plan to fill the void with nurse practitioners (NPs). This acknowledges the necessary role primary care plays in our health care system while ignoring the actual qualifications for the job. Furthermore, by failing to address why doctors are leaving primary care these experts unwittingly will ensnare us further in the same trap we currently find ourselves in today. Independent of whether or not nurse practitioners are qualified to practice medicine without a supervising doctor is the following fact: they are avoiding primary care medicine for the same reasons as doctors.
As we determine who will take the lead on providing primary care, we should consider what is best for our patients. Nurse practitioners fill an invaluable role by taking on many of the day-to-day problems and there is little doubt that our patients benefit from their skill and experience. Anyone suggesting that nurse practitioners can replace physicians should understand that the nurse practitioners’ training program teaches them to provide care within the structure of a healthcare team led by a supervising doctor.
What can doctors provide their patients that nurse practitioners cannot? Depth of knowledge. Seven years of study in medical school and residency provide a doctor with the depth to understand complex medical conditions more difficult than the average day-to-day medical problem. With experience, many nurse practitioners can provide excellent care for patients suffering a difficult or unusual problem; yet without that experience this lack of depth can be the difference between a good and bad outcome.
A very good nurse practitioner I work with once said, “I am only as good as the doctor backing me up, when I am working with a good doctor, I’m great.” This helps exemplify how nurse practitioners can rely on physician supervision to help prevent unnecessary tests, procedures, and misdiagnoses.
When a patient needs the care of a specialist, a nurse practitioner might find it difficult to advocate for the patient without the necessary parity of experience with the specialist. In my training, it was unthinkable to give absolute control of a patient to a specialist. Specialists need to focus often leaves them unable to best serve the overall interests of the patient. While no primary care doctor can perform a highly technical procedure on their patient, they can advise as to whether the procedure is necessary or not. Every patient needs someone to coordinate their care plan while keeping in mind his overall best interests. An unsupervised nurse practitioner may find it intimidating to tell the enthusiastic specialist “no” while advocating for what is best overall for the patient.
The idea that you can replace a doctor with a nurse practitioner does not address the underlying problems that will continue to drive all healthcare providers away from primary care medicine. I hope that anyone suggesting a solution for the shortage of primary care doctors tries to understand why the shortage has occurred in the first place. Then and only then will there be enough primary care providers to care for us all.
Until next time, I remain yours in primary care,
Steve Simmons, MD
Dr. Richard Carmona
Intense debate has broken out across the blogosphere regarding the candidacy of CNN medical correspondent, Sanjay Gupta, for the Office of Surgeon General of the United States. Some argue that he is not qualified for the position, others say that his charisma would be a boon to public health communications. But before we draw conclusions about who’s right for the job, we need to understand what the job entails.
I asked Dr. Richard Carmona, 17th Surgeon General of the United States, to explain the roles and responsibilities of the office. You may listen to our conversation by clicking on the podcast below, or read the summary of our conversation that follows.
[Audio: http://blog.getbetterhealth.com/wp-content/uploads/2009/01/surgeongeneraljob.mp3]
Dr. Val: What is the primary role of the Surgeon General?
Dr. Carmona: It’s the Surgeon General’s responsibility to protect, promote, and advance the health safety and security of the United States. The office of the Surgeon General dates back to 1798, when President Adams passed a law to create the Marine Hospital Service. The lead physician of the service became known as the Surgeon General. The Marine Hospital Service eventually became the US Public Health Service, and the roles and responsibilities of the Surgeon General broadened to include immigration, disaster preparedness (in the case of nuclear and biological warfare), national safety, health prevention, and many complex public health issues that face our nation and the world.
Dr. Val: What sort of experience is appropriate for a candidate of the office of Surgeon General?
Dr. Carmona: A successful candidate for the office of Surgeon General should have deep and broad public health experience, especially as a public health or uniformed military officer. The Surgeon General is given the rank of Admiral, and as such he or she will interface with other Admirals and Generals, and Army and Navy Surgeon Generals, most of whom are career officers with decades of experience in military matters. The Surgeon General must have the wisdom and experience to take on the position of an Admiral and represent our country internationally.
Dr. Val: What does the Surgeon General do on a daily basis?
Dr. Carmona: The Surgeon General is the commander of the US Public Health Service Commissioned Corps, which consists of thousands of officers in hundreds of locations around the world working anonymously to keep our nation and our world safe. The Surgeon General interfaces on a daily basis with the NIH, CDC, SAMHSA, HRSA, and all of the federally related health agencies as well as global health organizations like the World Health Organization, Pan American Health Association, and the American Public Health Association. The Surgeon General provides in-depth analysis of health policy for every cabinet minister, including the Interior, Commerce, and Homeland Security. It’s a very visible, credible, and iconic position.
Dr. Val: What’s the selection process for the office of Surgeon General?
Dr. Carmona: The Surgeon General is nominated by the President of the United States after much due diligence, and under the recommendation of his staff. The candidate is then introduced to the United States Senate. Then the Senate, if they so choose, extends the candidate the privilege of appearing before them for a Senate confirmation hearing. During the hearing they review the candidate’s credentials and ask him or her questions about anything and everything related to the public health of this nation and the world. You’re essentially put in a hot seat, and rightfully so because the Surgeon General is America’s face of public health to the world.
Dr. Val: What should Americans expect of their Surgeon General?
Dr. Carmona: The Surgeon General of the United States needs to remain a non-partisan physician. He or she should always communicate the honest, scientific truth to the American public so that they can make informed decisions about improving their health. Often, that scientific information is not the same as the policy that the President or Congress come out with, because policy is a very complicated process.
The Surgeon General has the largest medical practice in the nation (300 million), and when he or she issues reports, they actually change behavior in our country and the world. The Surgeon General is the true, honest broker of the best science for the people, offered in an a-political fashion. He or she is a patient advocate at the very highest level of government, and is expected to address the most complex health problems that face our nation. There is no more important or influential office that an American physician can hold.
Well, I’m a finalist in the medblog awards… but I need your votes to win. I’m pretty sure that I’m going to be crushed by Respectful Insolence – but it’d be nice to give him a run for his money. Any takers?
Thanks! 😀
My friend Kerri Morrone Sparling is also in the running for best patient blog.
The Washington Post reported today that Sanjay Gupta, CNN’s medical correspondent, is being considered for the office of Surgeon General by President-elect Obama. This came as quite a shock to me, as I’ve met and interviewed 3 of the recent Surgeons General over the past few years. Of course, I like Sanjay Gupta as a reporter. He’s a fine communicator and does a good job covering subjects for a consumer audience. But I don’t think he has the gravitas or appropriate experience for the role of Surgeon General of the United States.
I spoke with one source close to the nomination proceedings, and he said that most senior people were secretly disappointed with the choice. My source requested that I not reveal his name.
If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department. The office of Surgeon General is a very important position given only to the most senior and experienced medical professionals with decades of achievements in their fields. Gupta is a good reporter, he should consider a role in public relations for the U.S. government, not the office of Surgeon General.
When the Bush administration chose an inexperienced person, Mike Brown, to head FEMA – it was a disaster. I hope that the Obama administration doesn’t make a similar mistake with Gupta. However, a nomination is not a confirmation – Gupta still has to be approved by Senator Kennedy’s Health, Education, Labor and Pensions Committee before taking the office of Surgeon General. Unfortunately, it’s possible that the committee will feel pressured to confirm Gupta to maintain a good relationship with the new administration, rather than to vote their conscience. But I can tell you that many people are not pleased with this nomination, and feel that there are more appropriate choices that are being overlooked.
It will be interesting to see how far this nomination goes, and if there will be an outcry from the military and medical community over Sanjay Gupta’s apparent nomination. What do you think?
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