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Comment by elektor | Hacker News Reader

In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians.

The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health.

Source: https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-...

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> The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings.

I’ve been preaching this for ages, there’s a place for MD/DO’s but when you go in for a set of sutures, an annual physical, all sorts of basic procedures there’s simply no reason for anything but a PA or NPP to be involved.

Let mid level providers do their jobs without needing a physician to sign off on everything (many states have figured this out already) and encourage growth in these roles instead of saying “we don’t have enough doctors!”

I'm 100% on board. If you see how dentists run their practices you'll see the advantage of not being directly under the AMA. Not saying the ADA is a bunch of heroes but they're not the active enemy of America that the AMA is.

> We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health.

Can you give some examples of how other modern countries use telehealth and similar technologies as the basis of their provision of affordable universal healthcare? It has seemed like those countries were able to provide cost-effective healthcare without hand-waving future tech by rather boosting the supply in supply and demand.

> Can you give some examples of how other modern countries use telehealth and similar technologies as the basis of their provision of affordable universal healthcare?

In BC, Canada, there is the 24/7/365 BC Nurse's Hotline. (Healthlink BC)

It's a phone number, that you can call, to get medical advice.

"I have peanut allergies, and I am having an allergic reaction to peanut butter. I've taken my emergency pills for it, and I have an epipen with me. My symptoms are such and such. It's 3 am, and I'm at a provincial park's parking lot, 20 km out of town. Should I inject myself? Should I wait it out? Should I drive myself to the hospital? Should I call an ambulance?"

The practitioner at the other end will, given the information presented, provide medical advice.

The American reaction to this situation would be to go straight to the ER, regardless of whether or not they actually need it.

PS. In the exact situation I described, the person in question was told that someone should drive them to the ER (It turned out that they would have died, if they hadn't.) But, people call the BC nurse's hotline for all sorts of reasons, many of which do not necessitate a trip to the hospital.

Also how it happens in the UK.

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