On January 28, 1986, the Challenger air shuttle disaster occurred. The shuttle broke apart 73 seconds after takeoff. The cause: a flaw in the design of the O-ring seals on the solid rocket boosters which were not designed to withstand very cold temperatures. This flaw was previously known by managers at NASA (since 1977) but was never properly addressed. The day before the launch, engineer Roger Boisjoly, who worked for the company that developed the solid rocket boosters, warned his senior managers of this flaw and vehemently advised against permitting the Challenger launch to occur. His concerns were ignored by his managers, NASA managers and the head of NASA’s rocket booster program, Lawrence Mulloy. The launch went forward and 7 crew members were killed when the shuttle exploded. After the disaster, President Reagan appointed the Rogers Commission to investigate the accident. The commission ultimately found that, in addition to the issue with the O-rings, NASA’s organizational culture and decision-making processes had been key contributing factors to the accident, with NASA violating its own safety rules. Why do I share this story? Because it is a case study in how groupthink and workplace ethics (or lack of) can affect decision-making.
This is akin to what is occurring in the healthcare industry today. The corporatization of medicine is a testament to the violation of workplace ethics due to the need to meet metrics and increase profits. Hire individuals with little to no medical training and convince the public they are equivalent to physicians. Who cares about the healthcare outcomes? They are not germane to this business. Legislators, unable to break away from groupthink and possessing no desire to address the potential safety hazards to patients, pass laws allowing what should be illegal to become legal. Physicians are required to attend medical school and complete a residency, both of which must be accredited. Non-physician practitioners (NPPs), in SOME cases, have no such ENFORCED requirement. For instance, one need only possess a nursing license and one can become a NP, get certified and practice in any facility he/she wishes. The NP program may or may not be accredited. NO ONE CHECKS. Physicians must pass three licensing exams and 1-2 specialty boards, depending on their specialty, before they can be considered an expert in their chosen field of practice. And everyone checks before we are hired. Not so with NPPs. All they have to do is claim they are specialized and legislators and hospitals/employers accept it as fact. NO ONE CHECKS. Physicians must remain supervised for a minimum of 7 years before independence is granted. NPs in particular, who have no license to practice medicine, can in fact, practice medicine in 22 states and the District of Columbia without a medical license and without mandatory supervision. No consistent minimum number of years of supervision required. Straight from an online degree mill and into your local ED, hospital or clinic. No questions asked. AND NO ONE CHECKS BECAUSE NO ONE CARES TO CHECK. NPs claim studies that demonstrate equivalent or better healthcare outcomes compared to primary care physicians. NO ONE CARES that those studies used poor methodology. NO ONE CARES that those studies are based on supervised rather than unsupervised NPs which would make the study more relevant. Nope, it is more important to expedite access to care without confirmation of quality and be damned with the consequences. Then at least legislators can say they did something.
No VALID studies exist attesting to whether the care provided by non-physician practitioners (NPP) is sub-standard because no one expected nurses, PAs, psychologists (seeking prescription writing rights), chiropractors (claiming to practice primary care) or optometrists (lobbying for the right to perform eye surgery) to perpetrate physicians. Why would anyone perform a study for comparison when these disciplines and medicine are incomparable and distinctly separate? Unless one has an unseemly agenda? No one asked who would address the fallout from these bad decisions. No one asked who would treat the complications. No one asked who would pick up the pieces. Because those making the decisions to pass these unacceptable laws simply refuse to acknowledge that there is concomitant damage as a result of their actions. Instead, they claim that no such evidence exists. However, absence of evidence is not evidence of absence. It just indicates that NO ONE HAS CHECKED. Again.
Well we, Physicians for Patient Protection (PPP), are Roger Boisjoly. We are yelling “Don’t launch!” And legislators (and some physicians) are the senior managers ignoring the warning by those possessing the expertise to tell them that what they are about to do will lead to a disaster. Because we are treating the victims of those disasters today. One difference between the NPP fiasco and the Challenger accident is that the ramifications of these unfortunate decisions will not be visibly manifested — for years. When they are, it will be on a scale unprecedented by any previous issue affecting the public. Then legislators and physicians cannot claim that they were not given notice. They were. And they knew. THEY JUST DIDN’T CARE.