Irrespective to the damage the American’s Affordable Health Choices Act of 2009 (HR 3200) will do to the national debt (a 239 billion dollar budget deficit over the next decade), what it will do to the profession of medicine is repellent.

The hidden implement for defrocking American doctors as the principle stewards of patient care lies concealed in this 1018 page bill. On page 461 HR 3200 states “-(4) Participation of Nurse Practitioners and Physicians Assistants - (A) Nothing in this section shall be construed as preventing a nurse practitioner (consistent with state law) from leading a patient centered medical home.” The patient centered medical home remains the preferred care model adopted by this new legislation: the doctor’s office.

People will argue that state laws, at least for now, usually require physician oversight of nurse practitioners. However, in my state, North Carolina, there is no limit to the number of nurse practitioners a physician may supervise and physician review requirements of the nurse practitioner’s activities must only be performed once every 6 months. This allows nurse practitioners to practice medicine with very little restriction and now with HR 3200 gives them their own office.  Moreover, this bill changes the very definition of a physician.

Cloaked in the middle of page 445- “(C) PHYSICIAN- the term ’physician’ includes, except as the Secretary may otherwise provide, any individual who furnishes services for which payment may be made as physicians services.”

Thirty four pages later this bill repeals the section of the Social Security Act which defines a physician in this way- “The term physician when used in connection with the performance of any function or action means (a) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action.”   Incredulously, the American Medical Association and other physician organizations are on board with this legislation.  Why go through all this legal redefinition?  Where there is language in a bill that redefines anything look for a lobbyist and a willing accomplice in the government.

A coalition of the American Association of Nurse Practitioners attended a congressional briefing on May 9, 2009. From the AANP website regarding the briefing:

“The briefing emphasized the potential role of the nurse practitioner as a licensed independent primary care provider in health care reform.”

“It is recommended that the Institute of Medicine (IOM) definition of primary care (‘the provision of integrated accessible health care services by clinicians who are accountable for addressing a large majority of health care needs, developing a sustained partnership with patients and practicing in the context of family and community”) be utilized in the development of health care reform agendas and that nurse practitioners be recognized as primary care providers within that framework.”

In researching the origins of this push to socialize medicine, under every turned rock lurks the Institute of Medicine. This organization enjoys excessive power within our government. Among the affiliated cast of characters: David Blumenthal, Obama Health Technology Information Czar, and Ezekiel Emanuel, Obama White House Health Care Policy Advisor (both doctors of self loathing) who appear hell bent on turning a wonderful health system into a giant Minute Clinic--and for what…money?

A full time nurse practitioner earns approximately $86,000 a year.  Will this offset the health care problem? No, but nurse practitioners will likely submit to government standards as a way of compensating the government for elevating their status. Politicians view stubborn doctors (who take the Hippocratic Oath too seriously) as obstructive to their plan.

We doctors are on our heels in this fight. Outflanked by liberals in the government and in our own professional organizations it is time to regroup, educate ourselves about this issue and recognize we have let the enemy in through the front door via the patient centered medical home.  As I have said, the patient centered medical home is the Trojan horse which will destroy our profession. We have been betrayed.

Let’s get busy.