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Doctors Fight The Future in Kentucky

Rising costs are forcing major interest-group showdowns in the health care industry. The Wall Street Journal reports on one battle brewing in Kentucky, where physician assistants are fighting MDs to gain more autonomy and responsibility for caring for patients:

Physician assistants are lobbying the state legislature to repeal a law that says that for the first 18 months after certification, physician assistants are allowed to treat patients only when a supervising physician is on site. Being in phone contact isn’t deemed sufficient.

The Kentucky Medical Association, which represents doctors in the state, says it is still evaluating the bill. But it helped push for an on-site requirement in 2003 and helped block two previous attempts to rescind the 18-month rule, on the grounds that physician assistants have far less experience than physicians and benefit from more supervision.

The showdown in Kentucky is just the beginning. With computer-aided diagnosis getting better and more widely used every day, there will be increasing economic pressure to use less well trained professionals following computer-guided protocols at more and more points in the health care system.

In a perfect world, we would all have nice long conversations with top-of-the-line doctors for every sniffle or scrape. This just isn’t economically feasible. But while the concept of rationing or limiting health care up front is culturally unacceptable to most Americans, the idea of rationalizing it plays much better.

In the future, doctors, nurses, and other licensed personnel are going to gradually cede responsibilities to professionals with less training. Barring some sudden change of heart by the American people on rationing, the math just doesn’t work out any other way.

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