The doctor will not be in

Experts say there is already a shortage of physicians in many parts of the United States. And many are considering giving up medicine altogether due to their alarm with the coming government take-over of healthcare.

Well, brace yourself.

In 2013, the actual provisions under the Affordable Care Act (ACA) will make that shortage far worse.

So get ready. The most unpalatable aspects of the ACA (held in reserve until after the election) are about to kick in. Now, finding the right M.D. with solid credentials who can treat you appropriately using both modern high-tech medicine and natural alternatives may become next to impossible.

It’s not that every little cough or sniffle needs a doctor’s care. In fact, as I first discovered while working in Southeast Asia during the 1970s, not every medical situation requires a physician. As you might expect, most people in “third world” countries do not have easy access to doctors. In these countries, they get along without physicians in every community.

But in the U.S., it’s all about access to drugs and tests and more drugs.

So, what might the New Year bring for you? Who’s looking after your health as the U.S. health care system devolves ever more closely to something resembling what is found in a third world country? How exactly do the geniuses in Washington plan to make up for the staggering shortfall of qualified doctors that they will cause?

I fear the worst…

In 2013, look for the role of the pharmacist to grow. Indeed, that’s what most modern health care in this country is really all about anyway, right — access to drugs? To many in Washington it makes perfect sense to put the pharmacist at the top of the power pyramid.

In fact, a report from one year ago by the chief pharmacist of the U.S. Public Health Service already argued that pharmacists are “remarkably underutilized” given their education, training, and location within communities.

Plus, the Federal Government already provides a model where the pharmacist ends up in charge of medical care. In fact, today pharmacists working for the Department of Veterans Affairs, Department of Defense, and Indian Health Service can deliver care without medical supervision.

Indeed, once a physician prescribes drugs as the primary treatment, pharmacists take over. Federal pharmacists, after an initial diagnosis from a physician, can start, stop, and adjust medications. They can also interpret medical laboratory tests and coordinate care…all without physician supervision!

Is this what the Federal Government now envisions for everyone?

Thankfully, various state laws still make it difficult for pharmacists to replace your physician — but only if you’re among the shrinking ranks of citizens who do not work (directly) for the government.

Of course, many pharmacists are knowledgeable about natural remedies as well as drugs. I learned about this trend 20 years ago. Back then, pharmacists like my friend Alan Kratz led efforts to promote “natural pharmacy” in Florida. In addition, schools like the Philadelphia College of Pharmacy and Science (PCPS) still taught about “pharmacognosy” — the origins of medications from plants. My colleague, professor Ara DeMarderosian taught several such classes.

The PCPS also displayed exhibits of traditional plant remedies and held seminars on what modern physicians are rediscovering about the benefits of plant remedies. I even spoke at PCPS on more than one occasion.

But in my personal experience, pharmacists at your local CVS remain painfully ignorant and even hostile to natural alternatives. These retail chains have replaced independent-minded pharmacists with 9-to-5 corporate employees. The traditional compounding pharmacists — who used to make their own remedies — were open-minded entrepreneurs who ran their own shops. But they are being  pushed out of towns all across America and replaced by corporate pill pushers.  

So, this January, as you get back into shape and begin to focus once again on your health, talk to your pharmacist and ask him or her about the new ACA laws. Hopefully, you have one of the rare compounding pharmacists who is still around. If you use a retail pharmacy, ask your pharmacist about what they are doing for (or to) you under the new ACA.

Another major change in the U.S. health system in 2013 involves the continued proliferation of nurse practitioners. Nurse practitioners (NPs) typically have master’s degrees and more advanced training than registered nurses (RNs).

Last year, 18 states and the District of Columbia allowed NPs to diagnose and treat patients. They also gave NPs license to prescribe medications without any physician involvement. Expect that number to grow in 2013 with the new ACA changes.

Why are NPs suddenly so powerful? First off, it’s another backdoor solution to the doctor shortage. Why would a clinic pay a doctor to do a job they can pay an NP to do for half or less the price?

The second reason may surprise you…

At the typical university — which spawned NP training programs —  faculty agenda and advancement tends to focus on being politically correct.

You see, once upon a time, women primarily dominated the nursing profession. Men dominated the medical profession. To “correct” this inequity, academic faculty agendas inevitably involved gender issues.

Since then, NP programs proliferated and nursing faculties built new academic empires. In the meantime, there are now more women physicians in training than men. So, these modern, “politically correct” faculty agendas have become as outdated as the 1960s politics which created them.

 Your traditionally trained personal physician may indeed be on the verge of extinction. Aside from pharmacists and NPs, competition is also coming from retail walk-in clinics, community aides, and home healthcare workers. Plus, you’ll find increasing directives to simply care for yourself in your own home (self-care).

Of course, you’ve also read about all the unnecessary and counter-productive medical care now prescribed (in previous editions of the Daily Dispatch as well as in my monthly Insiders’ Cures newsletter). So, decreased access to a physician for the wrong kinds of medical interventions is not a bad thing for you and your family. Too many mainstream doctors still fail to consider safe and effective natural “alternatives” to conventional treatments.

Ultimately, much of what of you can and should do for your health does not involve just prescribing drugs. It lies outside the boundaries of what is defined as healthcare in the contemporary U.S.

But for complex or acutely critical medical problems, this new “affordable” healthcare system may represent the kind of care that we really can’t afford.  A rational healthcare system “reform” should provide the best of both worlds — modern high-tech medicine and natural alternatives — as suited to the individual and the condition.

Unfortunately, the ACA does little or nothing to move us toward that integrative goal in 2013. For most doctors and patients, it will simply be about ever-expanding government control over every aspect of our lives.