More on Non-Physician Physicians

In November of 2018 CVS purchased Aetna in another giant health care merger. CEO Larry Merlo announced that this would allow CVS pharmacies to provide expanded health care services including “guiding discharged hospital patients through their at-home plans and managing complex conditions.” CVS hires nurse practitioners because they can practice independently and cost about half the price to employ as a physician. The movement toward replacing physicians with nurse practitioners (and eventually physician assistants) in primary care is accelerating. Nurse practitioners are on average less intelligent and less well trained than family practice physicians. Does this matter in terms of delivering quality care in the long run? The surprising answer is: probably not.

Certainly some individuals will pay the price for this change, but remember that the average life span has increased over the past century from 50 years to 80 years due to clean water, vaccines, and antibiotics; all the rest has had little impact. Get those 3 things right and you institutionalize longevity. Physicians in the U.S. have on average the highest IQ of any profession Yet the best physician can affect the lives of only a few thousand patients. An inventor can affect the lives of millions. A policy maker or a general can decide the fate of nations. So having your best minds go into medicine may not be the best idea from a public policy perspective.

The real downside of replacing physicians with non-physicians will be the exacerbation of class conflict. As the middle class disintegrates, class struggle begins to heat up, and it eventually boils over. The first red flag was the report by the Census Bureau in 1985 that it took both spouses working full-time to buy the same house that the father alone could purchase in 1955. In the 1950s work was optional for most married women. The influx of millions of women and immigrants into the workforce drove down individual salaries to the point where married women in the 1980s had to work to maintain a middle class lifestyle; their children became latch-key kids. Since 1985 things have only worsened. Now, not only do we have 22 million illegal immigrants in the U.S. (according to the latest Yale-MIT study), but our workers compete against world labor as they are constantly being threatened with relocation of their factories to countries paying less than $10.00 a day.

In the future those who can afford to do so will seek out primary care physicians, and those who cannot will use nurse practitioners. In Britain, the rich opt out of the Public Health Service for private physicians. Almost all Brits believe that the rich get better health care because of this two-tiered system. This further undermines the unity of a society plagued by class conflict. The same will happen here.

– Gary Gallo, MD