Sam Bauman: Navigating the complex world of health care



As we age, we revisit our primary health practitioners more often for good causes. We’re older and our bodies and minds need help. I know I do. Our doctor’s offices are busy places where we may know some of the staffers, but not all. When our doctor wants us to see a consultant, that’s a whole new world.

Growth in medical professionals grew in 2000-2006 — medical doctors by 26 percent, nurse practitioners by 42 percent, physician assistants by 107 percent, doctors of osteopathic medicine by 113 percent, doctors of chiropractic (D.C.) by 103 percent, registered nurses by 59 percent. More medical help out there for sure.

Before, when you made a doctor’s appointment you would see someone who had four years of medical school and then had three years total training at a hospital. But these days you’re apt to see a varied collection of health care specialists: DO, PA, NP, RN and ND. Just who are these people and what do they actually really do?

The truth is, you may not always see a traditional doctor and may have a hard time finding one. The U.S. is short of doctors, particularly those providing primary care. The average wait time to see a doctor in the U.S. is 29 days compared with Canada where it was 19.5 days in 2014.

At the same time, today’s doctors are pressured to work faster because of competitive pressures in the marketplace, working for large corporations which set quotas for doctors of how many patients they should see in a day — often 16 to 25 is typical, which reduces the time the doc can spend with you.

So that results in “a team of responders.” That results in a time crunch. This, combined with the growing demands to document all of the doctor’s procedures, takes a toll on doctors. Then come the “advanced practice providers” such as the nurse practitioners, which you may run into at the doctor’s facilities.

This is a team approach. They don’t have as much training as the MD but are licensed to do many of the same things. The share of physicians with these clinicians has risen from 25 percent in 1999 to more than 60 percent today. Is seeing these professionals as good as seeing a med school grad? Yes, says Ateev Mehrotra, MD, at Harvard Health.

A study for health care found practices with more NPs and PAs had fewer specialists referrals and ER visits. The team approach is more efficient, allowing the doctor to spend more time with the patient.

Here’s a guide to who’s who, who gives advice and how to get the most of your time with each of them:

These days you might not even see a doctor when facing the flu, instead seeing a physician’s assistant. Outcomes are as good as when seeing an MD.

Medical doctor, MD: Four years of med school, and three years of rotating study. Plus two to three years under a practicing physician.

Doctor of Osteopathic Medicine, DO. Largely matches MD programs, adds hands-on manipulation to reduce pain.

Nurse Practitioner, PA. Focus on medications, family care, pediatrics. Fine for main health care provider; expect to be referred to doctor for some conditions.

Registered Nurse, RN. Qualifications vary by state. Vital to medical team, assessing symptoms, taking histories. Focus on patient education, can’t write prescriptions, must work under an MD or DO.

Families with kids — For the whole family, consider a board-certified family practice physician. You’ll stay with one doctor and get to know him or her.

Women — An obstetrician/gynecologist OK as PCP. Or consider a certified midwife (CNM).

People 65 or older — Geriatricians with special training with health concerns of aging people. Helpful with frail or handicapped patients.

Who should be your main PCP healthcare provider? He or she will provide care for routine health problems like sprains or the flu, keep track of medications and coordinates care with specialists. Used to be the family doctor of many years but may need to be updated today.

P.S. Look over your recent Medicare summary notice. Found that I may well be on the hook for $1,500! Not good news, but the rest of the statement is.

Sam Bauman writes about senior affairs, among other things, for the Nevada Appeal.


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