Chapter Eight ('The Future')

Non-Physician Practitioners in Primary Care
by
Timothy Bilash MD, MS
June 17, 1994
www.DrTimDelivers.com

based on
"The Roles of Physicians Assistants and Nurse Practitioners in Primary Care"
D. Kay Clawson and Marian Osterweis, Eds, 1993

1. 'A responsible individual whose performance is continuously reviewed and judged by peers is a more reliable guarantor of performance than an administrative system relying on credentials, rules, regulations.' (p109)
   
   
2. "Over the past 25 years, medical centers and medical schools have been distorted by a reward system that has overvalued research and new technological advances and undervalued the production of graduates to meet the recognized medical needs of average people." (p110)
   
   
3. 'Practitioners in community practice were content with their lot until the medical centers were no longer able to supply their replacements. At that point, overwork and burnout- not inadequate payment- began to force them out of practice.' (p110)
   
   
4. Successful redesign of curriculum: (p113-115)
   
   1. Make clear outcome objectives.
      
   2. Make clear relationship between each lecture and educational exercise and the outcome objectives.
      
   3. Make clear authority and responsibility for curriculum design; the overall curriculum is under the direct authority of the Program Director and a small staff of faculty directly responsible to him.
      
   4. Stress team learning- cooperative and compatible learning
      
      
5. Teaching time purchased from existing departments.
   
   
6. Problems with medical school training
   
   1. "There is no agreement among the medical school faculty as to what we are training. Each department is attempting to train a clone of it's own faculty. Medical students are never told what they are being trained to do, what is expected of them, or what they must learn to meet the demands of their future work." (p116)
      
   2. A crisis in medical education: "Many of our medical schools do not consider the education of medical students as the top priority among the several functions of the medical center." (p116)
      
   3. 'The process of educating PA's And NP's is essentially the same as that involved in the education of physicians." (p117)