April 30, 2010

Further practical considerations

Next in an on-going series of my evaluation of the real world implications of  various political actions.

There has been much discussion about the on-going and intensifying departure of physicians from the family medicine/general practice fields.  The reasons for this are manifold and are not the point of this post.  One of the more frequent suggestions is to permit, if not require, physicians assistants and/or nurse practitioners to take over many of the functions currently performed by physicians.  This includes initial evaluations, taking of histories, physical examinations and other such actions.

Here's a problem that I have not seen discussed elsewhere, possibly because it isn't that obvious of a problem.  What happens in workers' comp and liability cases when the evaluations and care are almost exclusively performed by a PA/NP.  This is not an idle question on my part.  For those who do not know, I work in the personal injury field, plaintiff side.  Many of our clients are receiving their primary care from a PA/NP for a work injury or after being in an accident.  It is routine for opposing counsel to attack the treating physician's opinion on the grounds that the treating physician didn't actually do the examinations and didn't actually take the history and is relying on someone who isn't a doctor to make medical determinations.  This line of attack has varying success but it is always, always done.  The theory behind this is that a PA/NP does not posses the requisite skill, training and experience to make medical determinations.  That is to be left to a physician.

So what's going to happen in the future?  The public is being told that a PA/NA is qualified to make those determinations and provide that treatment.  If that is the case, then what will happen on the legal side of it?  Will state workers' comp law be altered to require acceptance of a PA/NP's determination as to the cause of an injury?  What about expert witness qualifications?  Will a PA/NP now be deemed qualified to provide expert testimony in a medical malpractice case? 

The ramifications of the Health Care Reform bill go far beyond the obvious.

Posted by: alexthechick at 12:53 PM | Comments (3) | Add Comment
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