The Work Is Equal, Shouldn't the Pay Be Equal?

Monday, May 13, 2013 | 0

California Senate Bills 491, 492, and 493 (Hernandez) would allow registered nurses with advanced training, optometrists, and pharmacists to practice medical care without the pesky obligation of going to medical school, doing internships, or submitting to residency programs under the supervision of faculty. Indeed, most surgery would remain out of bounds (not all surgery, mind you!). 

The nurses, optometrists, and pharmacists would be allowed to undertake primary care. The RNs with advanced training would be qualified as nurse practitioners. Proponents argue that this largesse will reduce medical costs because lower-cost workers would take over some of the tasks done by physicians. Just where to draw the line is one of the problems. For instance, how does one "draw the line" when the differential diagnosis of, say, "numbness" is the chief complaint? Should an evaluation for multiple sclerosis be considered? The patient who is misdirected to the lower level diagnostician will find out the hard way.

The San Jose Mercury News, in an editorial on April 12, 2013, said "these bills ... would allow nurse practitioners to establish independent practices and deliver limited care without a doctor's oversight." It has also been argued that the lesser-level practitioner would be paid less. Herein lies a problem: if the nurse practitioner, optometrist, or pharmacist is delivering medical care equal to or on a par with physicians, shouldn't the lesser level practitioners be paid at the same level?

The Affordable Care Act is supposed to expand access to care, not to water it down.

Recently, we learned that the Union of American Physicians and Dentists negotiated a raise for physicians by showing that a group of nurses was being paid more than their physician counterparts. The opportunities in Hernandez's legislation make it worthwhile for physicians, nurses, optometrists, and pharmacists to organize into collective-bargaining units lest the Hernandez package be used to create equal work with unequal pay.

If the Hernandez package is passed, the nurses' unions would be asleep at the switch if they did not seek equal pay for equal work.

Dr. Robert Weinmann is a practicing neurologist in San Jose. This column is reprinted with his permission from his Politics of Healthcare blog.