To ease doctor shortage, let nurse practitioners do more

Enough doctors to go around? | Sept. 30, story

Let nurse practitioners do more

I compliment Letitia Stein for her article enumerating the troubles our state and nation have in getting sufficient primary care physicians.

Part of the answer should include nurse practitioners. NPs have been shown again and again in randomized studies to function comparably to physicians at primary care. Still, in Florida, archaic laws and turf-protection policies supported by medical societies hamper NPs willing and able to provide the care they are educated for. Additionally, NP education emphasizes incorporating health promotion and disease prevention into all aspects of care, not purely "sick care" — exactly what is advocated by so many.

In states such as Arizona, Oregon, Idaho, and many others, these obstructions have been removed, and NPs are doing their jobs. Florida is woefully behind in enacting sensible reforms.

We need to address our Florida shortage of physician education and training slots, but we also urgently need to remove the barriers to practice that will let the fully educated professionals we already have to ease the access shortage. Patients are suffering and access to care is being denied only to protect special interests while patients and the public wait.

Jeffrey P. Hazzard, St. Petersburg

Enough doctors to go around? | Sept. 30, story

Many things discourage people from being doctors

Letitia Stein's article states the problem but forgets about the reasons.

I started a urological practice here in 1975. My last year in medical school cost $4,000, total. Now it is $40,000. A doctor coming out of training may owe $200,000 or more. Malpractice coverage, which has to be paid up front, may be as much as $200,000 a year. A doctor has to have a car, a home and an office. Nurses and office personnel expect to be paid. Overhead over the past 40 years has doubled.

Surgical fees have been cut to one-third of what they were. Why do you think many surgeons are doing things like varicose veins and weight loss? Why are docs doing gyn but no more OB?

Then there is the ever-amassing amount of rules, regulations and restrictions. A doctor can no longer practice medicine as he is too consumed with jumping through hoops.

Of course there is a coming shortage of doctors. Only an idiot would go into medicine for the privilege of being told what to do, how to do it, going into debt, and worrying about getting sued.

Gary K. Keats, M.D., Clearwater

Enough doctors to go around? | Sept. 30, story

Ideas for easing shortage

I propose two reforms in our health care which should alleviate the anticipated shortage discussed in this article.

1. Replace the costly and dysfunctional malpractice program with a merit review and mediation program. We need to lose the lottery mentality, be more compassionate, and resolve "adverse events" with a mediation panel. The money saved could help fund the second reform.

2. Establish free clinics (or provide tax credits) for basic medical care. Nurses, physician assistants, residents in training could do the first care, which would include vital signs, history taking, physical examination, giving vaccinations, offering advice regarding healthy lifestyle changes, and possibly ordering selected generic medications.

This first-care provider should be able to perform adequate triage and recommend doctor consultations. Besides being readily available for first care, a significant burden would be lifted from our overused emergency rooms. The emergency rooms would revert back to true emergencies and not be a convenience clinic.

George Daicoff, M.D., St. Petersburg

Senate panel rejects public health option Sept. 30

Public option is essential

The Senate Finance Committee under the leadership of Sen. Max Baucus just rejected two proposals for including a public option in health care reform.

Sen. Baucus has said that his "first job is to get this bill across the finish line." I feel that his first job is to get a proposal through his committee that offers meaningful health care reform. Without a public option, health care reform will become the biggest health care insurance industry benefit package since the Bush administration passed Medicare Part D.

In opposing a public option, Sen. Orrin Hatch has said, "Washington is not the answer." But as usual for Republicans he offered no significant alternative.

If we ultimately get a health care plan that does not include a public option, we will not have significant reform and we will just be postponing the inevitable.

David Cimino, M.D., St. Petersburg

Senate panel rejects public health option Sept. 30

A new attitude?

For years a conservative mantra has been that government programs are inefficient and more costly to operate than programs run by businesses in the private sector. Suddenly I am hearing that a public option in the health care reform bill would drive private insurance companies out of business.

Have conservatives changed their minds about the effectiveness and efficiencies when the government runs health care? Seems to me that if conservatives are, in effect, conceding the public option would be less expensive, why not go that route?

John R. Hampton, St. Petersburg

Generous to the old, stingy with the young Sept. 29, Cynthia Tucker column

Parental responsibility

Cynthia Tucker says we have become an upside-down culture that spends lavishly on our seniors but is stingy with our young. She also considers the underlying finances of Medicare to be a form of welfare.

Most seniors have paid into Medicare all their lives, so how did it become welfare?

What happened to people having a family when they could afford to support their children and only having as many children as they could afford to support instead of expecting more and more entitlements because they have children?

Why did it become everyone else's obligation to provide for those children and their parents from womb to whenever?

Janice Trowbridge, Largo

Generous to the old, stingy with the young Sept. 29

Show some respect

Cynthia Tucker's tirade seems to characterize seniors who receive Social Security and Medicare (which she refers to as a form of welfare) as something like vultures taking food out of the mouths of babes.

We older people deserve better than this from you, Cynthia!

Shirley L. Waggoner, Largo