Can the New Health Practitioners Reduce Medical Costs? Part 1. Physician Assistants and Emergency Medical Technicians

Many people regard their doctors with ambivalence, or sometimes even hostility. We often leave the doctor’s office dissatisfied and resentful. The pressure is apparent—there is never enough time to talk about our ailments. Obviously the doctor’s patient load is often too heavy. Furthermore, the situation is aggravated by the doctor’s inability to communicate concern for our problems. 1 Doctors are not renowned for their public relations expertise. Most doctors were so busy working for grades in biology and chemistry so they could enter medical school that they never had time to develop adequate communication skills. As Lewis Thomas points out, their neglect of the humanities is tragic. z Once a student enters medical school, little attention is paid to developing a “bedside manner,” or the communication skills that help inspire a patient’s confidence. On the other hand, many people with excellent communication skills who are not as turned on by chemistry, physics, or biology have difficulty becoming physicians. Tradhionally, they have been discouraged from entering medical school because they lack high academic grades in pure science. For example, I might have been an excellent doctor—certainly more sympathetic than many I have encountered. However, at a time when there were at least 10 applicants for every medical schooI opening, a “B” in organic chemistry was considered a mortal sin. But this is really a digression. My point is, while we obviously do not train enough doctors to communicate with patients, we also do not make enough doctors out of people with good communication skills. Despite this, according to Frank Chappell, American Medical Association (AMA) science news editor, the AMA predicts there will be a half million physicians in the US by the mid1980s. s This will happen even though medical schools are unlikely to increase their enrollments. Added to the students graduated from American medical schools will be Americans who study medicine abroad. But even that number of doctors may not be enough because medical practice has become so specialized. So how do we solve the problem? One way is to train so-called paramedical personnel who can do almost anything doctors do, with or without their supervision. These paramedical personnel should be distinguished from lessertrained helpers such as medical secretaries, nurse’s aides, and orderlies. While they are important to the doctor, they cannot perform medical tasks. Whole new classes of health professionals have developed that provide medical care, thereby extending the services of the physician. Members of these professions—physician assistants, nurse practitioners, nurse-midwives, emergency medical technicians, and others—are trained to perform a n umber of medical tasks formerly reserved for the physician. By taking over many