The growing shortage of medical doctors, which will be made much worse by health care reform, will mean more and more patients are cared for entirely by "nurse specialists" and nurse practitioners, instead of physicians. Nurses are lobbying for increased prescribing privileges and for the right to be addressed as "doctor" in health care settings.

This substituting of nurses for physicians is evidence of a two-tiered system of health care in America sure to become more obvious in the wake of Obama-care.

People who can afford to bypass insurance altogether and simply pay to see doctors will increasingly do so. Why? It's simple_ Doctors go to medical school, which is much more rigorous academically and intellectually than nursing school. They also were admitted to medical school, which is a much more competitive process than being admitted to nursing school. The average doctor has more training, relevant experience and raw intellect than the average nurse--period.

Saying such things plainly isn't popular, of course. The fact that the health insurance premiums of Americans won't even get them access to the minds of doctors in many clinics and ERs and even ORs (where nurse anesthetists work behind gowns and masks, just like anesthesiologists) is one of the "dirty, little," gigantic secrets of how our health care system is giving consumers less for more. No one is supposed to offend anyone with the truth, anymore, after all.

Want a little truth right now? No man or woman in his or her right mind would prefer to routinely talk to an on-call nurse when his or her child is sick, rather than a doctor. No one sensible would want a nurse, rather than a doctor, assessing whether to get an MRI or CT scan or neither one after an episode of head trauma. No one would want a nurse, rather than a doctor, to decide whether to get a cardiac stress test in the setting of chest discomfort.

How come? Because doctors are the gold standard behind the devalued currency of your health insurance dollars. Everyone knows it, but people are too political to just say it.

How come no one is flying into an American city today to see a famous nurse, while people arrive from countries around the world to visit with noted American physicians? How come no one in Congress would be able to tell you a story about that incredible nurse who diagnosed the rare condition in his or her child? How come nurses either failed to be admitted to medical school or didn't try? You think it's because they thought nursing school would train them better to take care of patients? C'mon. It's because nursing school is easier--as in, 10 times easier.

I almost feel sorry to be so blunt. I don't want to hurt anyone's feelings. If nurses stop impersonating doctors, I'll stop writing about them impersonating doctors.

Until then, just follow the money; people with enough of it will hire physicians, every single time, when they have real health concerns. The vast majority of Americans, on the other hand, whose health insurance is rapidly costing more and buying them less, will see health care workers who chose not to go to medical school and probably would have been turned down, anyhow.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, "Living the Truth: Transform Your Life through the Power of Insight and Honesty" has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.