Our Patients Need and Deserve Physician-Led Healthcare

By Paul A. Pipia, MD | March 20, 2024

As policymakers look to measures to ensure patients receive the care they need, it is critically important for them to make New York a more welcoming environment for physicians and other care providers to deliver patient care.

We face shortages of critically needed primary and specialty care physicians all across the state, which are most acute in underserved areas. But efforts to recruit physicians to New York are stymied by the staggering costs of practicing here. This includes both the myriad of administrative hassles interfering with patient care delivery and our notoriously high liability costs, which lead to New York being regularly ranked among the worst states in the country to be a physician.

Governor Hochul is to be commended for various initiatives to address the physician shortage. This includes proposals to expand student loan repayment opportunities and modest increases to New York’s Medicaid payments, among the lowest in the country. She also vetoed crushing liability expansion legislation that would have undoubtedly exacerbated patient access to care problems.

However, there are a number of problematic proposals in the Executive Budget that could very well exacerbate these shortages. We strongly oppose the proposed repeal of the Committee for Physicians Health (CPH) program, which has helped thousands of physicians receive needed behavioral and addiction treatment services. We strongly oppose the imposition of tens of thousands of dollars of new costs on physicians who receive Excess Medical Malpractice coverage. And we strongly oppose several concerning proposals to eliminate important physician coordination of patient care delivery, including permitting Physician Assistants (PAs) to practice without any physician supervision or collaboration after 8,000 clinical hours.

We thank the State Senate and Assembly for rejecting these proposals in their respective one-House Budgets.

PAs, NPs, pharmacists, and dentists all provide essential services within our health care delivery system. However, we are very concerned with the adverse patient impact of completely removing the important oversight and coordination role which a trained physician plays in overseeing a patient’s care, particularly as it relates to the ordering of diagnostic tests, the evaluation of the effectiveness of various prescription medications and treatments and the ongoing assessment of the patient’s response to treatment. All of these oversight functions are essential safeguards in assuring that lesser trained professionals do not overlook important elements of a patient’s unique circumstances.

Multiple studies find that when non-physicians are permitted to practice independently, the difference in training results in increased health care costs and patient safety risks. Moreover, surveys on patient sentiment report that 95% of patients believe it is important that a physician be involved with their diagnosis and treatment decisions.

Every New Yorker deserves to have a physician oversee their medical care. There are a number of steps policymakers can take to expand availability of physicians, including increasing Medicaid payments, additional loan repayment opportunities for serving in underserved areas, and increasing the use of trained International Medical Graduates (IMGs).

Let’s work to increase physicians practicing in and across New York, instead of advancing measures that will enable large health care systems the ability to replace them.

Our patients deserve nothing less.

Paul A. Pipia, MD

The writer is the president of the Medical Society of the State of New York.


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