Nurses Can Practice Medicine — Only if They Work for Government
Full post by Robin Hanson is worth reading:
[Licensing restrictions] prevent cheaper medicine via nurses directly managing patients, even though randomized trials suggest nurses are just as effective…..
Most states have special laws allowing school nurses to directly manage students as patients. True, school nurses can’t do everything docs can, but nurses who offered these same services to passersby at a shopping mall, without direct doc supervision, would violate medical licensing laws. Apparently, we like the comfort of knowing that medical help is onsite at school, but know that an onsite doctor would be very expensive, and so compromise with school nurses.
For soldiers, we similarly like the comfort of having medics available near each soldier, yet know that requiring medics to be full doctors would be very expensive. So we also relax our usual medical rules to let medics to care for soldiers without being doctors, or under their direct supervision. But we refuse to relax such rules elsewhere in society. Why do we allow the exceptions of school nurses and military doctors, but no other exceptions?
One obvious common element here is that most medics and school nurses are government employees. This seems to be part of a more general pattern, whereby we often relax regulations for the government. For example, the military is also not subject to OSHA rules on workplace safety, and the worst asbestos and hazardous waste sites have been on government property. Congress has also exempted itself from rules against workplace discrimination and stock insider trading.
So why are governments often held to lower standards?
Government also has special rules to reduce the cost for itself when it comes to malpractice.
It would be in the interest of patients to put the turf battles behind us. Patients need the freedom to see; or not see, the provider with the credentials patients prefer or are willing to pay for.
I would bet a lot of the “medic on the battlefield” and “school nurse” exemption is related to the “that’s the way we’ve always done it” syndrome. But, yes, that does point to the fact that most nurses handle care rather well without a doc present.
Interesting post. I hadn’t thought about this before. But you are right. There is a double standard.
The medieval guild is still with us.
Government employees are held to lower standards because in most cases especially with the example of a school nurse as above, they arent being regulated or closley monitored by a governing body (for lack of a better term). Realistically as you mentioned above, there is not a school nurse at every school. In fact these days school nurses oversee and cover 4-5 schools. What happens to the children when a nurse isint present? With budget cuts in schools will school nurses be forced to cover even more ground?
I disagree with what you said about “compromising with nurses”. Many MD’s wouldnt know the first thing about triaging patients and managing them holistically the way that nurses do.