SGV Tribune Editorial

December 9, 2012

PHYSICIANS aren't the only doctors out there - though sometimes they, and their medical associations, would have you believe that's the case.
In addition to MDs, there are dentists, pharmacists, physician assistants, nurses, midwives, dietitians, physical therapists, psychologists, chiropractors, phlebotomists, podiatrists, optometrists, emergency medical technicians, paramedics, acupuncturists - and many more, very much including the specialty MDs such as surgeons and psychiatrists.

The best ones among the non-MDs are not only good at what they practice - they can be just what the, well, doctor ordered in their specialties when a GP just wouldn't do. Or not do as well.

In the United States, we came to rely on medical doctors to the exclusion of all other health care providers in the late 20th century more than any other society in the world did or does, for complicated reasons.

The best of those reasons was the rigorous academic training and certification process that saw physicians through undergraduate science programs followed by medical school and long years of hospital internships. Though it happened fairly recently in the grand scale of things - we are not so far removed from the use of leeches and from snake-oil salesmen - there was never a better-equipped group of professionals for what ails us than physicians after, say, 1950.

But Californians have always been more open than other Americans to what is sometimes lumped together as alternative medicine. A century ago, that often meant quacks of every kind. Today, the best chiropractors, acupuncturists and osteopaths - who are in fact medical doctors - are in the mainstream of our health care here.
As we move into the era of what is now known by friend and foe alike as Obamacare - medical insurance for all Americans, among other changes to our system - there's another very real issue: a shortage of physicians.

One out of three practicing physicians in the United States is over the age of 55, and many of them are expected to retire in the next 10 or 15 years, according to the HealthLeaders Media Council, a group of executives in the health care field. It also says that U.S. medical schools aren't in any way making up for the loss of a third of our physicians. Studies show that by 2020 the United States will be short by upward of 24,000 physicians.

State Sen. Ed Hernandez, D-West Covina - a licensed optometrist himself - has long been interested in looking at health care holistically during his legislative career. Last week he said that, in order to meet Californians' needs after the full implementation of the Affordable Care Act in 2014, he would introduce a package of legislation early next year that would "expand the health care decision-making powers of nurse practitioners, podiatrists, pharmacists and other health care workers in an effort to address the shortage of primary care physicians in the state."

The senator told a Sacramento radio station: "You need to allow them perhaps even the ability to diagnose - you need to allow them the ability to treat and to prescribe as well as work collaboratively with standards of protocol with physicians."

We are not at all sure that a grand expansion of the ability to prescribe medicines, for instance, is a good idea for California. But clinical pharmacists are often better-prepared than GPs to prescribe, and yet can't under current regulations. Nurses - highly trained and often with far better bedside manners than the docs - have long been ready for more responsibility in the field. And Hernandez also wants to encourage more medical school education, and more physicians seeing Medi-Cal patients.

Californians should wait to see the details from Hernandez before fully signing on to his legislative package. But we applaud the senator for getting out ahead of coming problems with these creative efforts toward health care reform.


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