SEE ONE, BUT DON’T BE ONE–THE IMPOSTER DOCTOR SYNDROME
It was early 2019 when I was offered the privilege to begin writing for the Authentic Medicine blog. I had a lot to get off my chest regarding the direction in which my beloved profession was headed. In July of that year, I gave my perspective on a disturbing paradigm shift that was occurring in medicine (https://authenticmedicine.com/2019/07/a-history-of-npps-a-personal-view/). That paradigm shift came to be known as “scope creep”–initiated primarily by nurse practitioners(NP) who no longer desired to work within a physician-led medical team. I discussed corporate medicine’s role in catapulting that movement forward in its haste to oust us physicians from our position on the team, and their profit-driven motivation for doing so. I also theorized as to why some physician assistants were beginning to emulate the NP scope creep model. At the time, I sincerely believed their incentive was to save their profession, which was being displaced by the unrestrained proliferation of nurse practitioners scurrying all over the United States, hounding legislators to legalize the illegal practice of medicine while simultaneously demanding they remove “restrictions” set in place to protect the public. But alas, the PA profession, like the NPs before them, have come to fully embrace faux physicianhood for the same reason NPs have–professional appropriation and pay parity. Also known as the practice of medicine by legislation, not education, they simply have no burning desire to do the work required to become an actual medical doctor–they just want to play one.
“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.–N. Newman, MD, Authentic Medicine blog”
Years ago I predicted the same issues that have surfaced with nurse practitioners being granted Full Practice Authority(FPA), aka the practice of medicine without a medical license by nurse practitioners, would also emerge with physician assistants if they were granted Optimal Team Practice(OTP). I still believe that. In January 2024, I wrote an article in which I shared that OTP, aka the practice of medicine without a medical license by physician assistants, was legalized in Arizona, now the 4th state to pass this absurd legislation (https://authenticmedicine.com/2024/01/sub-optimal-team-practice-passes-in-arizona/). They too have fallen non-victim to Imposter Doctor Syndrome. Some PAs aren’t even waiting for the laws to change. Dejá vu anyone?
Meet Trevor Schmidt, a Nevada Physician Assistant(PA) performing liposuction in October 2022. Not in his scope of practice(SOP), but what else is new? Trevor was reprimanded back in 2017 for poor record keeping of his liposuction procedures on multiple patients.
For some unknown reason, the Nevada medical board (BOM) did not admonish him for practicing beyond his scope at that time. His supervising physician in 2017 was a cardiologist. In February 2023, another complaint was filed against him. This time the complaint not only included poor record-keeping, but malpractice and practicing beyond his SOP. The patient was a 36-year-old diabetic(with previous gastric sleeve surgery) on whom he performed liposuction in November 2020, acting as both the surgeon and anesthesiologist. She ultimately developed an infection and was admitted to the hospital. As PA Trevor had no hospital privileges, he was unable to provide post-operative care. Actual, fully trained and licensed surgeons qualified to manage such patients repaired the damage. His supervising physician was an orthopedic surgeon–he didn’t manage the f**k-up either. That supervisory relationship ended in May 2021. The doctor was held accountable also(see below), as he should have been. During the period between 2010 and 2023, Trevor had seven supervising physicians. None were plastic surgeons.
The consequences of this PA’s current violations remain to be seen, as they are not yet posted on the Nevada Board of Medicine’s website. However, he no longer has a supervising physician, as is required in the state of Nevada. Again, the video at the beginning of this thread was in Oct 2022, yet his last supervisory relationship ended in 2021. Either he had a supervising physician in the video…or he didn’t. He also hasn’t learned from his mistakes because he is still performing liposuction which he proudly posts on Instagram. He has been reported. Again. It’s time for the Nevada BOM to revoke his license.
David McCleve is another Nevada PA who was reprimanded for performing liposuction in March 2022 on a 62-year-old woman with a history of hypertension and hypercholesterolemia. No documented pre-operative assessment. He performed the Smart Lipo Laser procedure, WITHOUT the patient’s consent. To make a long story short, the patient ended up in the intensive care unit with hypotension & necrotizing fasciitis. His supervising physician was an emergency physician who had just graduated residency in 2017. Yes, physicians must be reported also when negligence/malpractice occurs as a result of notional supervision.
A summary of both cases from the Clear Health Care Costs blog. Clear Health Care Costs is described as “a journalism company from New York City bringing transparency to the healthcare marketplace by telling people what stuff costs”.
Moral of the story: FFS physicians, stop “supervising” s**t that is not within your scope of practice.
Keep in mind that except for the 4 states alluded to above, PAs are mandated, by law, to be supervised. Liposuction is most certainly not within their scope of practice. Now, if this s**t is happening in a country in which PAs are regulated and licensed, imagine the disasters waiting to happen in the United Kingdom where PAs are unlicensed, unregulated and do not possess a defined scope of practice. Nevertheless, they are permitted to practice on human beings. Supervision by a medical doctor is mandatory…but we in the U.S. know how that goes–notional supervision is a thing. Members of Parliament and traitor trash doctors can blather all day about how UK PAs are “highly qualified” and can practice at the “top of their license”. How can they practice at the top of their license when they don’t have one? U.S. legislators made similar claims regarding the practice of nurse practitioners. It is that nonsensical belief has contributed to the mess that is U.S. medicine today. Patients should be able to sue legislators who enable this s**t. Wouldn’t it be better for all to ensure that the public and/or their loved ones are protected by the safe practice of medicine? How difficult is it to just do the right thing? Apparently, it must be extremely arduous since stories like those shared in this article are becoming more and more common.
It is truly disheartening that the leaders of the American Academy of Physician Assistants(AAPA), taking their cue from the American Association of Nurse Practitioners(AANP), have opted to idolize the nurse practitioner scope creep movement. Many PAs take issue with being “lumped in” with NPs; however, their leadership did that when they chose to align themselves with the roguishly raggedy pro-scope creep nurse practitioners and FPA. OTP is simply FPA…by another name. I have zero empathy for their plight because the PAs that oppose OTP are not publicly lobbying against these bills. They are remaining silent. In their silence, they are complicit and ineffective. The physician assistant education model was NEVER designed for independent practice. The AAPA has made the conscious decision to proceed with OTP despite this fact, because they just don’t give a f**k. Practicing authentic medicine is not what they seek. Again, it is pay parity and a misperceived prestige in being conflated with physicians–same as nurse practitioners, whose specious actions they have chosen to mimic. The deceit continues….I proclaim, loudly, that I will offer no support or goodwill for such an egregious endeavor. F**k ‘em.
“Just because something isn’t a lie does not mean that it isn’t deceptive. A liar knows that he is a liar, but one who speaks mere portions of truth in order to deceive is a craftsman of destruction.”
― Criss Jami
References:
1. ”Imposter Doctor” is a term taken from the title of the 2023 book, “Imposter Doctors-Patients At Risk”, written by Rebekah Bernard, MD.**
The ironic thing is emergency room doctors are complaining that plastic surgeons are reluctant to take call.
Then the same emergency room doctors open competing liposuction and Botox clinics. But the emergency room doctors don’t have to take call, in fact quite often they call the plastic surgeon because they say their ” too busy ” in the ER. Or the nurse practitioner calls the plastic surgeon because they don’t know how to suture a child The plastic surgeon most of the time is not paid for call but has to provide this service despite competing against physician assistants and nurse practitioners that don’t have to take call. This after medical school and a 6 to 7 -years of surgical residency. And then being called in to take care of complications from the physician assistant, again quite often on compensated because the patient doesn’t have insurance or is on Medicaid.
Oh yeah, I called ’em from the ER and they said, “Put saline soaks on the wound” and they dealt with it in the morning. A plastics guy or gal never came in at night. Ummm, actually that worked out o.k. for the patient as I had the bastid H&P done and the plastics person could take the patient to surgery for the fix. What a cush job. Yeah I know there was a butt load of training. In the “olden days” a plastics person had to have a DDS degree first because they dealt with a lot of facial stuff. Then did Med school and THEN did general surgery and THEN did the plastics fellowship. That was the requirement in the “olden days”. I worked with some of the old timers and dang! They were good! I saw some fantastic free flap transfers in my day with micro surgery artery and vein anastomosises done by a plastic surgeon! Nowadays they probably are required to have a vascular surgeon doing that “chit” in the room because of turf wars. Those docs are likely all dead now but man were they good!
Cue the LELT outrage. I really hope some militant NPs or fellow traveler PAs get on here to debate with you Natalie, I really, really do.