Who needs diabetes DOCTORS?

“Are Doctors Really Necessary in Diabetes Care?”

There is a principle in the computing world called Moore’s Law. Simply stated, computing power doubles every few months to years. At some point this will level off, but for now it’s still increasing. Medical knowledge also doubles every few years and has been expanding at a staggering pace. Yet with this knowledge explosion, the human capacity to absorb and apply it remains relatively static.

We are already facing the consequences of this knowledge-action imbalance in medicine. The need for health care providers has never been greater as the number of persons with diabetes explodes. To fill the growing provider gap, health care delivery has turned to developing more “physician extenders”, a euphemism for non-physician health care providers. The advantages are straightforward: these caregivers require less time to train and cost less to maintain, plus they have most of the authority to provide the same care provided by licensed physicians. Typically, they require a licensed supervising physician who can oversee their work plus review a small percentage of their medical records. But even this is starting to change.

The medical management of diabetes is ripe for the application of non-physician providers. For years, diabetes has been viewed as a multi-disciplinary problem anyway, so there has been ample opportunity for many non-physician health care providers to develop considerable experience in its management.

Plus, many physicians welcome the relief in busy, high volume diabetes clinics due to the often repetitive nature of the problems faced every day (patient non-adherence, insurance/financial problems, forms and prescriptions, etc…). It’s a perfect storm scenario. Nurse anesthetists consititute another discipline where this shift has been overall successful.

Specialist practices often employ physician extenders. And frankly, many patients don’t know the difference, and many don’t care. In my practice, many patients and their parents believe the primary care physician assistant or nurse practitioner who referred them to us IS a doctor. I will state for the record that I have worked with diabetes nurse practitioners and physician's assistants very effectively. They are AWESOME.

Most of us want a provider who listens to us, has sufficient knowledge of our health concerns, can effectively address our problems, and communicates well. We are now at a point in the practice of medicine where that person might not be a licensed physician. As it stands now, there are far too many persons with diabetes than can be seen by diabetes specialists. Approximately 80% of persons with diabetes are cared for by primary care providers. So it’s not unreasonable to think that some specialty practices might enlist the skills of non-physician specialists too.

Of course there are still many patients who insist on seeing a specialist consultant with all the training, credentials and accoutrements that go with that designation. Others might not be so insistent.

So this sets up the questions I wish to pose to my readers: what are your thoughts or feelings about receiving diabetes medical care for yourself or your child or teen, exclusively from a non-physician specialist?

If that is already happening, has your experience been positive or mixed? Or, does such an approach leave you wanting something more? I look forward to reading your comments.

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