When Hell Freezes Over

Earlier this year I was reading an article entitled, “The Death of Expertise”(https://thefederalist.com/2014/01/17/the-death-of-expertise/?fbclid=IwAR0PTqplHQQSRifprtAOjY7u9dDYyTGyKFBGcaBwTwbQNF_PlxamhF8RVZs). It was a brilliantly written piece of work expounding on the current cultural phenomenon of individuals possessing a particular aptitude for a particular skill or specialty being challenged by those who have no proficiency in said skills. The fact that the demand for proof of prowess has no real basis in fact is irrelevant. To the challenger, it seems perfectly logical. Any pre-existing, well-founded evidence is dismissed and replaced by whimsical thought and baseless opinion.

I too have been baffled by this same assertive attitude in medicine. Non-physician practitioners(NPPs), particularly nurse practitioners(NPs), with no medical training, insisting physicians demonstrate that their healthcare outcomes “are better” than those of NPs. Legislators, whose knowledge of medicine is damn near non-existent, demand the same. To make such a claim, one must presume that medicine and nursing are equivalent. How can they be? Nursing is nursing, medicine is medicine, and neither the twain shall meet. The training models are completely different, as are the licensing boards and the licenses themselves. That I have to clarify this is ludicrous. One cannot compare apples and potatoes, they are incomparable. Yet, that is exactly what is occurring in this scenario. So then one must ask how is it possible to compare outcomes between the two? It isn’t. But the so called data exists stating that their outcomes are equivalent, right? Balderdash. If one legislator with a degree of sense and research experience would review one study, the lack of quality of the study would become apparent. Most, if not all of the studies, utilize SUPERVISED NPs. One must again ask, how does one compare outcomes for UNSUPERVISED NPs using data for SUPERVISED NPs? That alone should indicate that the study is irrational. Nevertheless, attempting to convey this to those who have a vested interest in maintaining such illogical thinking is an exercise in futility…Let’s just say it would be much easier to move the Rock of Gibraltar. What we are witnessing is fiction becoming fact as a result of persistent rhetoric. Imbecilic.

No one would demand that attorneys prove that their outcomes in criminal cases are better than those of  paralegals. It is safe to assume that the attorneys would have a higher success rate because they have more extensive training and expertise. I submit that if a defendant was standing before a judge and jury awaiting the decision on a life or death sentence, he would most likely take his chances with an attorney. Yet, in medicine, not only is our expertise questioned, nurse practitioners have the unmitigated gall to suggest that they are actually equivalent to physicians. And for legislators to expect us to prove they are not is beyond insulting.

There are some things that do not require evidence because, by their very nature, the answer is apparent. So allow me to school you. Teachers do not have to demonstrate they are more qualified than student aides to teach students, it is presumed based on training and education. Attorneys are not expected to prove mastery of their craft for the reasons stated above. The same applies to physicians…or it should.

Our medical educational system is modeled after Johns Hopkins, an undoubtedly premier medical and academic institution. It is a result of the Flexner Report which mandated the standards of medical instruction which continues to be followed to this day. This model ensured that medicine would be safer, more consistent and of higher quality for the public to receive optimum care. THAT WAS ITS PURPOSE AND THAT PURPOSE HAS NOT CHANGED. Nursing has no such standard. Not today.

The practice of medicine has never guaranteed perfect outcomes. Ever. How can it when those practicing it are imperfect human beings and fallible? However, one can be assured that there will be less chances of errors(compared to NPPs)based on training and aptitude. Practice makes damn near perfect. There is an assumption, culturally, that when a physician’s services are required, it is the highest level of competency that is expected. And that is with good reason. Because of the extensive training and education that is REQUIRED to understand and practice medicine. The human body and its ills ain’t no joke. 

I can absolutely say, WITHOUT COMPUNCTION, that medicine is safer when practiced by those licensed and trained in it. That would be physicians. Does that indicate all physicians are safe? That would be silly and I need not qualify that further other than to say dangerous physicians are why medical boards exist. The high standards of medical training have endured hundreds of years since the Flexner Report. Thus, by extension, so have the standards in the practice of medicine. Cannot say the same about nursing. Education matters. Standardized, quality education matters even more. Lives depend on it.

Legislation cannot make nurses into physicians. Sham doctorates obtained online in less than 2 years does not create physicians. Hijacking medical terms typically used in the medical lexicon does not a physician make. Long white coats and a “white coat ceremony” makes no one a physician, an expert in medicine nor anything else for that matter. Medical school and residency. That’s it. That is the path to physicianhood…and mastery of the practice of medicine.

“The practice of medicine is the gold standard by which all other disciplines of health provision are measured. The onus is on them to prove, with VALID evidence of sound quality and unquestionable standards and methodology, that their discipline measures up.”

Lesson over.

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Natalie Newman MD

Dr. Natalie Newman is a residency trained, board­certified emergency physician who has been practicing for nearly 24 years. In 1991, she graduated from California State University in Sacramento, California with a degree in Biological Sciences. She then attended medical school at Case Western Reserve University in Cleveland, Ohio on an Army scholarship. As a graduating senior, Dr. Newman was presented with the Marjorie M. and Henry F. Saunders award for her compassionate care of patients within the family structure. After her graduation in 1995, she was accepted into the Emergency Medicine Residency at North Shore University Hospital in Manhasset, New York. Upon her graduation in 1999, Dr. Newman entered active duty service with the U.S. Army. Her first assignment was at Womack Army Medical Center in Fort Bragg, North Carolina. During her stint in the Army, Dr. Newman was deployed to Bosnia­Herzegovina(formerly Yugoslavia) where she was Chief of the Emergency Department at Eagle Base in Tuzla, Bosnia. She had the honor of serving under the command of Colonel Rhonda Cornum(now a retired brigadier general), a urologist, pilot and former prisoner­of­war during the Persian Gulf War. While in Bosnia, and as the only American female physician in the Balkans at that time, Dr. Newman was assigned as the personal physician for Queen Noor of Jordan during a humanitarian visit to a local hospital in Bosnia. After her return home to the U.S., she was promoted to Major and completed the rest of her Army service at Fort Bragg. Dr. Newman subsequently returned home to California where she continues to practice as a traveling physician and participates in multiple speaking engagements about the values of education, of which she is passionate. She is also a member of Physicians for Patient Protection, a patient and physician advocacy organization. 

  7 comments for “When Hell Freezes Over

  1. September 9, 2019 at 12:53 am

    In Missouri an NP is required to prominently display that the patient will be seeing an AP RN and has the right to request to be seen by the doctor.

    I last worked Assisted Recovery Centers of America (ARCA, arcamidwest.com).

    The staff finally stopped calling me a “provider”, now they call the NP only staff doctors (that’s right, there is NO physician on site, ever, since I left over billing fraud).

    They make 60% direct profit on every doctor visit, the execs run a shell pharmacy benefit company. . . At least with DPC no one is telling me to hurry up! (other than my family 😉

    God bless the system.

  2. Soccerdoc11
    September 8, 2019 at 5:18 pm

    As a Family Practitioner for 40 years, I know my limits and they are constantly changing. If a patient I refer to a trusted specialist gets referred to someone with a unique expertise, I tell my patients that even specialists have specialists–always with the patient’s best care in mind. There is no shortcut for training and experience.

  3. Natalie Newman, MD
    September 8, 2019 at 12:40 pm

    Who doesn’t realize that legislators are whores? Indiscriminate ones at that–they will bend over for the highest bidder. If a population of people who don’t have the funding, education and access to power that physicians do can move mountains, why can’t we? Cesar Chavez and the United Farm Workers union–improved conditions for migrant farm workers and gave them a seat at the table. No education, poor English skills and no damn money. The Civil Rights Movement. I will let that speak for itself. We have no excuse. Docs can still speak up and out as a unified voice about this atrocious health care system and so can the public. We hate it, the public hates it. Now if we can harness that energy we can alter the course of medicine. It is within our power.

    I feel strongly that if legislators dismiss the will of the people, it is our job to remind them of their duty to us and if they fail or resist, they are fired. The Constitution grants us that right; however, many of have relinquished our duties and legislators now dictate to us. They don’t know medicine, we do. They should not be telling physicians what to do. We should be telling them.

    “…But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right(the people), it is their duty, to throw off such Government, and to provide new Guards for their future security.” Now apply that to those who abuse their positions to destroy medicine. ‘Nuff said.

  4. S T E V E
    September 7, 2019 at 3:03 pm

    If you see someone in scrubs and a long white coat with 2 pagers and a cell phone on her belt and a stethoscope around her neck, you can bet she’s not an MD.
    It’s our own damn fault. We abdicated our authority to them for our convenience and now we’re paying the price.

  5. Steve O'
    September 7, 2019 at 1:55 pm

    One division that can be made in knowledge is the grouping of tacit vs. explicit knowledge. Medical school graduates have sufficient amounts of the latter so as not to harm patients while learning the former. ..

  6. Steve O'
    September 7, 2019 at 1:55 pm

    One division that can be made in knowledge is the grouping of tacit vs. explicit knowledge. Medical school graduates have sufficient amounts of the latter so as not to harm patients while learning the former.

  7. George Voigtlander
    September 7, 2019 at 1:25 pm

    I agree with you. But you have to realize that legislators are easily bought by drug store chains, industrialized medical concerns and other rich entities These buy laws that benefit them. A NPP is cheaper and therefore more profitable than a better trained MD or DO. In medicine sometimes you get what you pay for. The AMA and other organizations can’t out spend the for profit group that has bought control of medical legislation in this country.

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