In the original 2011, version of this article (then entitled simply Physicians Must Brand Their Role in Healthcare or Suffer the Consequences), I correctly predicted that the role of the physician as the principal provider of healthcare was in danger.
Over the ensuing 6-plus years, hospitals have continued to benefit from the expanding role of paraprofessionals and from the top level professional degree, the doctorate, that those paraprofessionals are obtaining.
In 2011, I cited the example of nurse anesthetists’ push to be recognized as equivalent to anesthesiologists. Hospitals, seeking to break the financial and medical staff voting block hold of anesthesia groups, are often more than willing to accept CRNAs in place of anesthesiologists. They view them as cheaper, more controllable and disposable.
I cautioned that just because you might not be an anesthesiologist, don’t think this doesn’t apply to you — in a very real sense, anesthesiologists are simply the “canaries in the coal mine.” In fact, I predicted that PAs would soon be pressing for freedom to act independently.
I recently came across an article that describes a hospital’s move to replace its M.D. hospitalists with PAs. Why? Because they’re cheaper.
In the words of a patient, who was portrayed as not being bothered that a physician assistant was in charge of her care, the PAs “seem knowledgeable and they’re easy to talk to. I feel comfortable with them.”
“Easy to talk to” tells you something about your need to relate to patients. But “seems knowledgeable” is by no means equivalent to “is knowledgeable.” If it were, hospitals could simply hire out of work actors from their day jobs at a restaurant near you to play physicians of all sorts. They’d seem really, really knowledgeable.
At the same time as paraprofessionals are pushing for more authority, doctorate degrees are becoming the top professional degree in many of their fields. Once the nurse specialist performing your function becomes a “doctor,” you will become irrelevant – or so goes the thinking of hospital-centric healthcare pundits.
Physicians do have one important branding tool, the “M.D.” degree. Of course, as paraprofessionals become branded as doctors, too, the value of an M.D. will become diluted. Physicians cannot allow that to happen, and your professional societies must take a far more active role to educate the public on the difference between M.D.-delivered medical care and the care delivered by nurses and other physician extenders holding doctorates. I’m not denigrating the role that nurses and PAs and other paraprofessionals play; rather, I’m asserting that if there’s not an actual distinction in the difference between their education, skills, and training, and those of physicians, then medical school and residency is a scam. I don’t believe that for a second. But who might?
Additionally, physician specialty boards, which to the public are generally meaningless (after all, what do all those initials after a physician’s name mean?) must devote significant resources to promoting the public’s awareness of the high-level of training and peer-reviewed expertise required in order to earn that designation and, even more importantly, what that actually means to patients and their families.
It’s bizarrely amusing, in a sick sense, to see hospitals demanding that all physicians in a contracted group operating a hospital-based department be board-certified, while, at the same time happily replacing a significant portion of those doctors with far lesser trained nurses and other professionals.
