Expansion of Nurse Practitioners and Physician Assistants Setting Stage For Single Payer Health Insurance

In the article “Are Nurse Practitioners and PA’s Taking Emergency Physician’s Jobs?,” the author gives an excellent summary of the evolution of the roles of “formally” ancillary providers.

While the dictionary defines ancillary as “subordinate, subsidiary, or assisting,” the article provides statistics on the rapid growth of ancillaries and the expected goal that these second-tier providers will practice in an increasingly autonomous fashion in the future. The majority of ancillaries support “team-based” physician-run practices but do not have decision-making capacity in the practice itself.

With modern technology, advanced training, and prospective financial savings, an ancillary-based model is clearly in the cards for Emergency Departments, urgent care facilities, pharmacy clinics, and other care-delivery locations in the future.  These will likely work with a physician supervisor overseeing a team of ancillary providers (“boots on the ground”). Supervision might occur simply by walking from room to room, over phone lines, or even via video (telemedicine).

With the ever-increasing costs of medical care and difficult access for many, using PA’s and Nurse Practitioners for direct patient contact makes a lot of sense. Will quality suffer? With the availability of direct supervision or advice through communication devices and telemedicine, decrease in quality should be minimal. Studies have shown that the general public is not only supportive of ancillary providers, but appreciate the concern and “bed-side” manner many are able to show, especially compared to negative experiences many have had with more hurried physicians.

In the recent governmental health care debacle over the ACA and “Trump Care”, there is little discussion of cost savings. Media reports show that legislators speak in terms of premium reductions and deductible amounts, and think that having an insurance card equals having medical care. How wrong!

Quite likely, the case for single payer health insurance will be on the table before long. And then, one might see a public safety net system that has premier options for those able to pay out of pocket. NP’s and PA’s will unquestioningly play a significant role in such a more socialized structure.