I guess that all comes down to whether you think someone needs a full residency to safely be a physician. As military GMO positions demonstrate, there is at least some utility in internship trained physicians. And as physician assistants and nurse practitioners demonstrate, one can certainly function with far fewer clinical hours and years of training independently.
I think we can agree to disagree on both those accounts. There may be some "utility" but that falls far short of being able to practice safely. Those who’ve done a GMO will tell you that it was a great learning experience with the steep curve, however after subsequent residency training they will also tell you, if they’re honest, how little they actually knew. I’ve never met a single person who didn’t realize at the end of residency how much more there was to know.
And then there are the positions outside of "normal" medicine that require a medical license, such as clinical research trials, basic physicals for plasma centers, etc, where board certification is probably overkill. Could probably get away with doing cosmetic botox injections or vitamin infusions for hangovers like any midlevel hack could.
Botox injections can actually be dangerous with possible permanent nerve damage a potential complication. I would not say that any "midlevel hack" could be doing them (the fact that they are doing them is a different problem for. different thread). I had a Botox injection by a BC plastic surgeon and ended up with a mild case of fortunately temporary ptosis. An NP I know who works in another plastic practice had *no idea* how to fix it despite “being trained” to do them (I ran into her randomly, did not seek out her advise).
That being said, I think there is a role for limited licensure for those who don't finish residency and limit practice to doing things like you've mentioned. They do not need to be BC.
I guess it's one of those areas where I'm fine with letting the market decide. Insurers won't reimburse for physician services that are billed by non-board eligible individuals, which limits a lot of the damage that can be done, and malpractice exists to catch anyone who decides to cast too broad a net with their scope of practice. If a big enough problem arises, the law will deal with it. We've been giving intern-trained physicians licenses for around a century without issue though, so my guess? Things are fine.
False/SDN fallacy. While some insurers may choose to do that, I have a partner who is not BC nor BE and is on every plan we take, and is reimbursed at the same rate as the rest of us. What she can't do is operate any more, which is fine with her (and us).
Just because we've been giving interns unrestricted licenses for a century or so, I wouldn't say its "without issue". There are plenty of documented cases about PGY1 only trained doctors doing harm, not being able to handle the complexities of patient presentations, etc. A practice in vogue in the days of Flexner isn't necessarily the best SOP for our times, IMHO.
