William Halstead was a coke fiend who said that medical residents should practice like coke fiends in order to get their skills up. He's been dead for 97 years yet the AMA clings to standards and practices that kill 200,000 patients per year. Here's how the EU does it: ...yet medical outcomes in Europe have been consistently better for decades. a maximum work week of 48 hours a minimum rest period of 11 consecutive hours per 24-hour duty a minimum rest period of 24 hours per 7-day duty, or 48 hours of rest per 14-day duty a minimum of 4 weeks of paid annual leave a maximum of 8 hours’ work in any 24 hours for workers in stressful positions a minimum 20-minute rest period per 6 hours worked
Right on about Halstead, dude was crazy. It's a ridiculous model that definitely contributes to the rate of errors and burnout. So the obvious solution is easing the burden of care currently on US resident physicians, which will require hospital systems either to supplement heavily with midlevel practitioners or take on more residents. Midlevels still have to get physician oversight in most states, so even a solution pursuing strict midlevel expansion will require more residency spots. And after residency positions are expanded, there has to be some sort of incentive to ensure that the new attending doctors get to areas where they are needed, i.e. poor and rural communities. This will be a multi-decade transition process, and only tackles a part of the train wreck that is the American healthcare system.
The urgent care model is basically filling in around the gaps, providing an inefficient and expensive mirror of European care. Rather than have a community health clinic that goes "take an asprin/have a vaccine/go to the emergency room" we have strip malls full of nurse practitioners going "take an aspirin/have a vaccine/go to the emergency room." The AMA has effectively priced themselves out of the market - if you can run an urgent care facility with a nursing degree why the fuck would you go to medical school?
Well, if I'm not mistaken the prescription pad is still out of the domain of nurses. Urgent care is expensive and inefficient in comparison to Europe's model, but are their community care clinics run by NPs? Genuine question. I don't know much about European healthcare. In terms of being able to run an urgent care facility without doctors, I think the majority of centers in the US still keep a physician on site. Nurse practitioners, in our current model, function best to help multiply care access but are still linked to physicians. Whether we should change this is a different discussion, though. I'm not sure if you're saying that primary care physicians are too expensive or something else, but I think there's a theoretical model that ensures high pay for all medical professionals (nurses, doctors, technicians...) while keeping costs low for the patient. It involves drastic moves in the world of admin, insurance and pharma, though, so - not gonna happen.