JohnDO said:
I'm not sure I understand the purpose of all this. If people wanted to be physicians or function like physicians, why didn't they just go to medical school?
Because they want all the benefits with none of the drawbacks, risks, and sacrifices. Anyone who asserts otherwise-- such as by proffering that they're concerned about "access to care"-- is kidding themselves, exceptions to the rule notwithstanding (i.e., there are some who are genuinely concerned about access or patient care, but these are not the rule, considering that the situation is, in most instances, not dire).
The fact is that medical school is the most difficult of the professional schools; when you throw in the grueling 3-8 year residency, all the more so. Some dentists may quibble by saying that they take the same courses alongside med students, but the fact remains that the pressures are not the same-- they're not competing against the "creme de la creme", so to speak, nor is the same mastery of the material expected of them (since it would not have as severe repercussions as it would for a medical doctor in most cases). Also, keep in mind that when I say that the medical track is more difficult, I'm speaking of the whole shebang: undergrad, med school, residency, and the obligations of the profession in general. Med school candidates are held to a much higher standard in undergrad if they hope to gain acceptance to a US med school; they also have to jump through many more hoops (research, extracurriculars, higher GPA and supplementary courses etc.). Some dental or PA candidates may do all this, but, again, this is the exception rather than a matter of course.
And this is not to demean any of these other professionals, as if they're somehow less intelligent or valuable-- not at
all. The rigors of the professions, in terms of responsibilities and standards, are simply vastly different, and there's no value judgment there-- that's just the way it is. And it's a
hard road because of all this. Is a person who has a Master's degree necessarily any less intelligent than one who holds a Ph.D? Of course not.
In light of the stringent standards for pre-meds, medical students, and MD's in residency training programs, it's not surprising that many people are put off by the whole process, yet they may still have some of the same goals (noble goals, such as to help others etc.) that many doctors do. However, such idealism can become misplaced and can ultimately be of detriment to the patient, as is the case when ancillary professionals decide to attempt to operate outside their scope of expertise and training, and to circumvent traditional limitations on their practice by way of politico-legal challenges rather than
equal (note: not "increased"-- "equal") standards.
In addition, this trend is indicative of a larger shift in American society, towards people who simply "do not know their place", and refuse to acknowledge the differences in expertise between various professions, and to suppose themselves capable of providing similar services just because their
own (subjective) experience, in their respective training programs, was difficult (to them). This is pure subjectivism being exalted as keen insight. After all, when a PA or NP announces indignantly that they've "trained just as hard as a doctor", what decent person has a desire to belittle their training and expertise? No one of good sense, obviously, because that would be rude. Yet at some point, it becomes clear that we cannot allow such importunate voices to set policy by dint of their subjective, emotional appeals. The fact remains that if they want equal rights and responsibilities, then it is only proper that they undergo
equal training (again: not "increased", not "some extra courses"--
equal). This strikes me (and most reasonable people) as eminently sensible. You never see a 2nd year law student agitate for the ability to try cases in court, and you never see a middle manager push for CEO-level scope of influence, yet we tolerate that very mentality in medicine. Why?
The drawbacks of undertaking a career in medicine:
- incredible time investment, both in terms of length of training as well as the reduction in "free time" incurred; this starts in undergrad and never ends, pretty much
- debt load
- litigation concerns and ultimate responsibility for a patient, which can be a daunting prospect
- the difficulty of completing the training
- being "on call" all the time in many instances; the strain on one's personal life
- the incredible continuing educational investment even after certification
The benefits of medicine:
- Being able to help others in the fullest sense (i.e., not limited to, say, the oral cavity)
- financial rewards (though even this is being eroded; PA's and CRNA's make more than pediatricians in many instances-- is this just?)
- intellectual stimulation and sense of accomplishment that is tied to the rigors of the training
Now, notice that all attempts to increase scope of practice are ultimately aimed at gaining some of the benefits of medical training
without suffering any of the drawbacks. In fact, it's mostly financially motivated. Many midlevels are quick to paint physicians as "greedy" because they bristle at the notion of expanding the midlevel's scope of practice, yet these very same people exhibit protectionism which is just as fierce when it comes to their own professions and the encroachment of even LESSER trained people on their sphere of influence. So it's disingenuous in that sense. At least physicians-- if they are, in fact, being "greedy" (and I don't think that desiring commensurate compensation can rightly be termed "greedy")-- have undergone the most rigorous training; with that comes certain rights. One of these rights is not having midlevels telling you how to do your job, and another is (or should be) not having to worry about undertrained professionals muscling in on your territory without
equivalent training. It's as if all the holders of master's degrees around the nation started petitioning their legislature to allow them to be granted tenure as professors at universities like their Ph.D counterparts-- it's ridiculous, quite frankly.
The number of logical fallacies employed by people like NPtobe are
astounding; I'm not sure if she'd get through an introductory philosophy course with the quality of "reasoning" she's exhibited here. I mean, seriously, how can you say this:
NPtobe said:
If I was interested in specializing then I probably would have gone to med school...Besides I'm not trying to play doctor, I'm a nurse trying to expand my scope of practice by taking on more responsibilities. A proud nurse not a MD wanna be. If I wanted to be an MD then I would be.
...with a straight face and not see the glaring contradictions present? Really now...
This post was NOT an effort to demonize anyone's efforts or their professions (be it MD, NP, PA etc.). However, I firmly believe in standards, and since the
standards for becoming a medical doctor have been fairly constant for decades, and since it has been common knowledge that certain things are
only within the scope of practice of an MD,
how can such attempts at encroachment upon these rights and responsibilities logically be defended unless it is accompanied by a call for
equal training? That is, if one wants to do all these things, then they should go to medical school. Makes sense to me, and I'm not even a doctor. I'm at least glad that I have the good sense to realize that different professionals have different standards and, hence, different functions and responsibilities. Anyone who denies this much-- as is evidenced by agitating for increases in scope of practice-- is clearly both unsatisfied with themselves (i.e., they have some sort of inferiority complex; and this, despite the fact that being a doctor does
not make one any more intelligent or a better person than anyone else-- all it means is that you have undergone certain rigorous training which confers certain rights and responsibilities), and does not possess the requisite intelligence, in terms of the functionality of their critical thinking apparatus, to provide medical care at the highest level, which is what they aspire to.
Like I alluded to earlier, this trend only mirrors a larger sociological trend-- it's simply one manifestation of the same societal illness. And make no mistake, behaving in the way that some midlevels (like NPtobe) do, by agitating for privileges typically afforded physicians, is not only indecorous, it is
absurd. I can say with the utmost confidence that only those who either have a chip on their shoulder (i.e., an inferiority complex) or have an IQ below 100 engage in this sort of practice-- and those suffering from
either of these conditions should not imagine themselves capable of providing "high quality medical care" in the first place. It's just utterly foolish. It endangers patients' lives and health solely for the sake of one's self-esteem; such arguments are eristic at best, dangerous at worst, and should not be tolerated by any sane individual.
continued in the next post...
