“Doc In A Box Clinic” in Tennessee.
Here in Washington state our two research universities are having a fight. The University of Washington, located in Seattle, has what is rated as the number one program for primary-care and rural medicine. To a large extent the high rating results from the fact that the UW offers a degree that can be pursued by students not only living in Seattle but students living in the rural part of our state or in Wyoming, Alaska, Montana, and Idaho. This program is called WWAMI.
The war has arisen because our football rival, Washington State University, now wants to have its own medical school. The reasons for this are curious. WWAMI is far less expensive and far more prestigious than any program WSU can develop on its own. The real reasons appears to me to be political pork that would come from the funding needed by the state to support a second administration and second faculty in Spokane. Add in the capital cost of creating a second medical school and one wonders who is supposed to pay for all this?
The only other rational explanations is prestige. The title “Doctor” means a lot in our society and WSU wants that prestige. Of course, the WWAMI program could easily be changed to award the degree from WSU instead of UW. I wonder, however, how many kids would prefer the less prestige of a degree from Cougar U rather than an MD from a school rated as one of the top 10 in the US and number 1 in primary care?
Why not expand the supply of nurse practitioners?
There is, however, another alternative. Washington State was one of the first states to allow broader nurse autonomy and more states are now considering giving nurse practitioners more independence thanks to the Affordable Care Act. Besides its highly rated School of Medicine, the UW also has a number one rated School of Nursing. As described in today’s Puget Sound Business Journal, there are few things that graduates of the UW’s advanced nurse practitioner program cannot do. If the goal is filling basic care gaps in rural parts of eastern Washington, advance practice nurses are far less expensive to train or pay then doctors. One huge reason for this is that the practical training of nurse practitioners does not require the hugely expensive facilities of one or more modern hospitals that can offer the residency training all doctors require .. an expense that could easily cost Eastern Washington 100’s of millions of dollars if not more. Moreover, while only about 30 percent of new physicians go into primary care, opting mostly to become specialists, that number is much higher for nurse practitioners at about 70 to 80 percent. Elizabeth Hunter-Keller, a nursing professor and spokesperson for the University of Washington School of Nursing says “We’re expanding, and that’s how we’re going to be contributing.”
Filling The Need: Put Nurses Practitioners and Physicians Assistants into the Doc In A Box clinics!
Anyone who drives around Seattle today will find that “Doc-in-a-Box ” clinics are opening up everywhere. These are sometimes called urgent care or walk-in clinics. The Doc-in-a-Box may be manned (if I may use an old word) by physicians assistants, medically trained pharmacists, or nurse practitioners. A very sick similar situation exists at the UW itself. As a diabetic I am fortunate to have a very high level UW diabetologist. However, for much of my care Dr. Hirsch sends me to other people, especially pharmacists, who help me with my medications and the other day-to-day issues facing me as a diabetic.
The idea of the doc in the box has important economic consequences that should appeal to the Republicans that dominate our State’s legislature . Not only do the doc in the box operations use the free market to greatly decrease costs, these clinics offer an opportunity for profit. For example, the CVS drugstore chain is dropping its sale of cigarettes and beginning to build the kind of in-store expertise that I expect will make the drugstore of the future an enhanced doc in the box. Add in web based support from a regional medical center and people living anywhere, including our farmlands to the East, would get better care. Why not?
We Already Train 250 Nurse Practitioners at the UW
The Puget Sound Business Journal reports that the UW’s Doctor of Nursing Practice program – the degree needed to become an advanced nurse practitioner – currently enrolls about 250 students. Marie Annette Brown, a primary care nurse practitioner and professor at the UWSoN describes the Advnaced Nurse Practitoner degree, “We’re the best kept secret I feel sad that we’re spending time and resources arguing about that (the UW-WSU medical school conflict) when really what we all need to do is get more of a commitment to primary care physician providers in this state.”