DOCTORS' LOUNGE
(continued from page 27)
What students of medicine – and primary care students, the
APRNs and the PA students need – are not just teachers, but patients
to learn from. Doctors learn from seeing sick and injured people, and
we remember them individually, by the lessons they have taught us.
We have patients in our offices, and we need to teach students there.
According to the Association of American Medical Colleges
(AAMC), there is not one medical school in the country that teaches
the history and physical exam online. Lots of research has focused
on the standardized patient and lots on the use of the simulation lab,
working with faculty and small groups of students in the medical
school setting. But the real patient has the edge on all of them: real
findings, real emotions, real distractions, real questions.
Currently, of the schools I could contact directly (school holidays
in force at the time of this writing), the University of Kentucky doc-
toral nursing program, the Northern Kentucky University and the
Bellarmine University Masters’ degree programs for Family Nurse
Practitioner: all have their physical exam courses online only. The
same holds for the University of Cincinnati. However, the University
of Louisville still – thanks be – has classroom-only teaching for their
students for physical assessment, as well as for pathophysiology and
pharmacology. Dedra Hayden runs the clinical assessment course
and she is a terrific teacher.
I could not find online any detailed written curriculum standards
by any national accrediting agency for APRN programs. All of the
online-only university programs above, however, are fully accredited
by either the Commission on Collegiate Nursing Education or the
Accreditation Commission for Education in Nursing. To get that
accreditation, their curricula must meet the standards of the state’s
Board of Nursing.
What I would like to know is, who decided this was adequate?
Who felt that APRN students, who are expected to do the same jobs
as the internist/med-peds and family practice doctors in primary
care offices, will be at all prepared? Why did graduate nursing
faculty members around the country agree to abdicate their re-
sponsibility to teach? Was it just for the convenience and revenue
from online programs? How carefully does our Kentucky Board
of Nursing examine the candidates for graduation? Why is there
no mechanism for a licensing clinical practical exam (not a paper
test) by a state certifier?
We need more doctors to serve as preceptors for APRN and PA
students. We need to help with “nurse residency” programs that have
sprung up in response to the stark reality of the short, superficial
and rushed NP programs. We are responsible to protect the public
and we need to help our nursing colleagues.
After all: you can learn a lot online, but not how to take a pulse.
Dr. Barry began a part time “float/fill-in” only position at various Norton CMA offices
in February. She is a clinical associate professor at the University of Louisville School
of Medicine, Department of Medicine.
MEDICAL DEBT AND BANKRUPTCY:
AN AMERICAN DISGRACE
F
28
AUTHOR Michael Flynn, MD
inding data and information about
medical bankruptcy in developed/
first-world countries other than the
US is not very productive. The simple
explanation is that medical bankrupt-
cy is not an issue in other first-world
countries. In 2017 there were zero
medical bankruptcies in France (1). France’s
single payor system provides medical care for all citizens. for as long as a decade.
There were just under 800,000 bankruptcy filings in the US in
2015. In any given year, around 60% of US bankruptcies are related
to illness and medical costs (2,3) . This effects primarily low and middle
income families, including the 75% who have health insurance. The
consequences include loss of assets, including the family home, and
any savings or inheritance. Ruinously, one’s credit rating is degraded In 2014, 64 million Americans carried medical debt, the leading
cause for bankruptcy in the US (4) . Massachusetts is the only state
where medical debt is not the number one cause of bankruptcy
because of a law retaining the individual mandate which requires
health insurance (5) . The 2017 GOP tax bill eliminated the individual
mandate from the Affordable Care Act.
LOUISVILLE MEDICINE
When a patient has a medical event like MI, cancer, trauma
with limited health insurance (short-term coverage) followed by
the financial ravages of the current health insurance marketplace
which include deductibles, copayments, surprise medical bills and
uncovered services: these lead to financial ruin. After a few rounds
of chemotherapy or a hospitalization and post-op rehabilitation, the
disability leads to loss of employment and income. The end result
is 500,000 American families suffering bankruptcy each year (3) .