For years, this blog has discussed the issues of others referring to themselves as doctors. This “trend” has now reached a point such that patients, not knowing who is who, are placed at risk. A few of our writers had been discussing the term “Cultural Appropriation” and how it relates to the field of medicine. We came to the conclusion that a similar phenomenon is occurring with nurse practitioners (NPs), physician assistants (PAs) and other non-physicians (NPPs). The new term we have coined is “Professional Appropriation”. Examples of this issue are ubiquitous:
- The use of terms/phrases such as “residency”, “fellowship”, “board certification” and “attending” which, in reality, do not resemble anything remotely consistent with the medical version of these titles.
- Claiming to be a “specialist” or possessing self-proclaimed medical “expertise” in a given specialty without completing medical school, a medical residency or taking mandated medical licensing exams or designated specialty boards(ie: cardiology, dermatology, anesthesiology, neurology, family medicine, intensivist, hospitalist, etc.).
- Demands to be referred to as “collaborators” or “physician associates”, which implies that their practice is equivalent to that of physicians.
- NPs’ use of the idiomatic expression, “brains of a doctor”, managing to offend anyone who is not a physician.
- NPPs failing to inform patients that they are not physicians.
- Claiming equivalency with 1/10 the training and education of doctors.
- And so on and so on and so on……
The misappropriation we personally find most offensive is the hijacking of the “White Coat Ceremony”. A ritual that is deeply rooted in the history of medicine and which signifies the journey of a medical student towards earning the long, white coat associated with physicianhood. It represents a symbol of not only professionalism, but the compassion we must give to and the trust we must earn from our patients. Now PAs and NPs have their own white coat ceremony…not at all representative of its significance when it was created for doctors by Arnold Gold, MD.
Call it what it is. Theft. Misappropriation. Deception. Dishonesty. Fraud. All for a fallacious sense of achievement. Stealing what is good and rejecting the bad while simultaneously truncating the journey. No concept of not having earned that right by paying your dues. It is that which incenses physicians. It is not about turf. It is not about money. It is not about ego. Those are accusations that make us easy scapegoats. It is about ethics. It is about decency. It is about honor. There exists an innate sense of entitlement with appropriation in which there is absolutely no recognition of it as being offensive or inherently disrespectful.
“In the broadest sense, cultural appropriation is the adoption or taking of specific elements (such as ideas, symbols, artifacts, images, art, rituals, icons, behavior, music, styles) of one culture by another culture.”
We submit that “professional appropriation”, in medicine, is the usurpation and perpetration of perceived ideas, symbols, behaviors, roles, practices, etc. by a separate and distinct OTHER discipline to gain acceptance, prestige, respect and/or acknowledgment for actions promoted as medical accomplishments, when those “accomplishments” have not actually been appropriately earned.
There are reasons why certain groups support the “professional appropriation” by non-physician practitioners. And we are not just referring to the lobbying groups behind NPs, PAs and other NPPs. Of course they are behind it because that is their purpose; to perpetuate falsehoods in order to advance their agenda, which is to achieve parity with physicians without the investment required to become a physician. However, other contributors underwriting this disturbing trend are hospitals and insurers. You know, the same ones fighting price transparency. For them, it is about money and nothing else.
What truly disheartens us is when some of our physician colleagues endorse these acts; that is training, then enabling the use of non-physician practitioners to practice in roles/specialties that takes physicians decades before they are permitted to do the same. In their complicity, they place patients at risk and demonstrate contempt for their colleagues when they are dismissive of an educational model that has withstood the test of time for over 100 years. This blog has said it for almost twenty years and we will say it again. Education and training matters. Titles only garner respect after the journey to success is complete. Attempts to bypass and shorten the journey simply to expedite reaping the rewards are nothing to be admired. No one likes a cheater.
So, where do we go from here? Well, that is up to you. Do you want to save the profession? Do you value what you’ve earned? If the answer is yes, then spread the term. Make “professional appropriation” an accepted phrase (but unacceptable act) so that those organizations who claim to represent us (AMA, AOA, AAFP, AAP, ACP, etc) use it and do their job to protect us. Most importantly, you need to push back when NPPs attempt to appropriate your job. Because if you don’t, then someday you may not have one.
(This article was written by a group of authors here at Authentic Medicine. No one person will be taking credit or blame. Any comments that come off as vicious attacks will be deleted).