Should Most Common Prescriptions Be Over the Counter?
In a move generating some expected controversy the Obama administrations health wizards are contemplating releasing many common prescription medications to over the counter status.
|FDA may let patients buy drugs without prescriptions...|
Various hypertension, diabetes, cholesterol, migraine, and asthma medications are being considered and pharmacists are excited about the expansion of their roles. Many primary care doctors are not happy about this potential move though.
Pharmacists and other non physician practitioners have the knowledge and skill to address mild and moderate issues which will result in cost savings to the feds. They also do not have the experience to appreciate potentially deadly issues at the same level as MD's. The convenience to patients will be offset by the probable increased cost of these meds and the insurance companies will not cover many of them anymore. I mostly agree with this pharmacist here,
"We think it’s a great development for everybody — for pharmacists, for patients and the whole health care system,” said Brian Gallagher, a lobbyist for the American Pharmacists Association. “The way we look at it is there are a lot of people out there with chronic conditions that are undertreated and this would enable the pharmacists to redirect these undertreated people back into the health care system.”
The article also quotes internal medicine physicians and I agree with this statement.
“The problem is medicine is just not that simple,” said Dr. Matthew Mintz, an internist at George Washington University Hospital. “You can’t just follow rules and weigh all the pros and cons. It needs to be individualized.”
Here's how I see this for primary care. One of the few ways private docs survive is the easy meat of medicine. A common cold, routine medication checks, follow up blood pressure/diabetes/cholesterol etc. The infirmed and elderly take far more time (and time is all we have to charge for unlike many specialties) and the compensation is just abysmal for a lengthy consult, often not even covering the overhead of the office let alone any profit. People buying OTC meds for serious issues will often expect a doctor to pick up the phone for free and talk to them about it, fat chance in our brave new world, and people will be lucky to even get a secretary to acknowledge a question and put it in the pile of 100 daily issues that the doc will never get to. Primary care will end up all government, hospital or insurance employees if they have no entrepreneurial spirit or go full private no insurance and charge what the market will bear. The last scenario is what I do now but the feds are always threatening to shut us outside the box people down even though we still are out earned by all the subspecialties, especially procedural based ones. The feds just cannot stand anyone in medicine beyond their control. If this happens then getting to a doctor for any routine item will be impossible as no one but a pure masochist would ever enter the worst paying field (with the most paperwork also) of medicine.
So we have pros and cons regarding this bold step. On many levels I am for the move. Of course the administration never dreams of real tort reform which would generate a 15% savings at a minimum, but that topic is for another day.