There’s an African adage that states: “The ground suffers when two buffalos fight”
The cold war between Physicians vs Associate Physicians and Other Health Professionals is the most protracted professional war in the history of healthcare leadership and the multidisciplinary medical team for the protection of professional territoriality.
The complexity of medical conditions and the changing dynamics of emerging diseases requires expertise from the multidisciplinary professions for holistic medical care.
The god-complex of doctors: A delusion or reality
The art of human healing and the preservation of life is the subject that does not subject to any headline or facets of living discussion. Life achievements and universal discoveries of historic significance are preceded by life: one must live first, and live healthy.
Therefore, the preservers and promoters of good health, the foundation of life, have automatic recognition, spotlight and critical role in the world; whether they’re organized profession, individuals, established society or emerging professions.
The medical profession dates back to antiquity; the medical practitioners appeared in different forms and had variety of approaches to healthcare. Some would later transform into an organized orthodox society (Medical Doctors, Physicians) with a protected nomenclature and identity; and others would retain their traditional identity (naturopathic physicians, homeopaths, traditional doctors, herbal doctors) of natural healing.
Associate physicians, clinical Officers, assistant practicing physicians) have been in existence since 1540 and during the Franco-Prussian war in 1870; they existed as Feldshers with a wide range of clinical and surgical duties. These types of physicians would later be formalized through unique traditional training and culture to address specific national needs with distinguish roles of bridging underserved communities to quality, affordable, and accessible healthcare. These professions have accelerated and expanded the past centuries contributing immensely to healthcare.
The growth of associate physicians including other members of the multidisciplinary team (advanced practice registered nurses, nurse anesthetists, nurse practitioners, optometrists, and psychologists) have been perceived as encroaching the territorial integrity of orthodox physicians and labeled as a greater threat to be fought by blood and sweat.
Physicians are the most insecure health practitioners in the health sector who have been jittery about their roles and relationship with other healthcare contributors; the fear of losing the top spotlight and diminishing aura of delusional god-complex has transformed an empathic profession into a political bully where no other professional matters.
Michael D. Hogue, the 15th Executive Vice President and Chief Executive Officer of the American Pharmacists Association (APhA) in an article co-authored with Lee Vermeulen, Executive Vice President and CEO of the American Association of Colleges of Pharmacy described the American Medical Association (AMA) as a “bully: unprofessional, completely disconnected from reality, and intent on getting their way no matter what is in the best interest of patients. This may explain why it is very difficult to find a practicing physician who agrees with the current AMA position on non-physician health care team members, much less one who is even a member of AMA. In fact, what we have discovered is that most physicians’ reactions to recent AMA statements on what they call “scope creep” has been largely one of embarrassment with many physicians on social media platforms openly criticizing AMA for being out of touch”
In her book “Patients at Risk: Imposter Doctors”, Rebecca Bernard expressed superiority complex of delusions about the role of physicians in healthcare and the contributions of associate physicians/ clinical officers and other advanced practice healthcare professionals worldwide;
Meaning of Physician and Doctor
The term “physician” has been around since the days of Aristotle, and derives from “physik,” an ancient Greek word for “nature.” Physicians were those engaged in the study of the natural world. Hippocratic physicians understood illness as part of the natural order and sought explanations for illness in the physical world. They constructed a system of elements (earth, air, fire, water), qualities (dry, cool, hot, wet), and seasons (fall, winter, summer, spring) and related them to constituents of the human body, known as the humors (blood, yellow bile, phlegm, black bile) ( source, AMA)
Doctor comes from the Latin word for docēre for “teacher,” meaning “to teach”, and originally referred to a small group of theologians who had approval from the Church to speak on religious matters. Eventually the term saw greater use referring to qualified academic and medical professionals
“Doctor” would later signify a physician who had received formal university training (usually with a heavy emphasis on the teachings of Aristotle and Aristotelian logic). Thus if one wanted to be technically correct in applying the terms “physician” and “doctor,” one would say that Hippocrates (who lived around 400 BCE) was not a doctor, although he was a physician
Thus Associate/Assistant physicians are physicians who understand illness as a natural order and doctors by formal university training to doctoral level; with protected nomenclature.
AMA criticism of remote medical training vs applauded remote medical interventions
The AMA has criticized the training of all other healthcare professions boasting of the long duration of medical training and education in a contemporary world where educational technology can defeat time in traditional medical training. While remote medical training of associate physicians and nurse practitioners are criticized, the physician community applauds remote surgical interventions such as robotic laparoscopic surgeries.
In what is described as groundbreaking medical achievement, Dr. Luo Qingquan successfully removed a lung tumor from a patient located3,000 miles away using advanced robotic technology. The procedure was conducted from the Shanghai Chest Hospital while the patient was in Kashgar, Xinjiang.
An observer-blinded 1:1 randomized controlled trial of thirty-eight participants (fourth-year medical students) were recruited into virtual reality (19) and traditional (19) groups, to evaluate virtual reality as a training model for orthopedic surgery and surgical training at large. . There were trends in all categories favoring the virtual reality group. The VR group had improved time to completion (9.6 minutes vs 12.2 minutes, P = 0.034) and reduced need for corrections within the mock procedure (2.2 vs 2.5; P = 0.05
Virtual reality training was more effective than traditional training in learning and completing the steps of the tibia IMN surgery for novice medical students. Virtual reality training may be a useful method to augment orthopedic education and surgical training.
Global healthcare leadership replacing stereotypic leadership
Emerging diseases such as the COVID 19 pandemic revealed a weak healthcare system and failure of Physician-led healthcare leadership worldwide and called for all hands on deck which included non-medical professionals and civil society. The world triumphed and contained the pandemic by embracing pluralistic healthcare and acknowledging leadership from various professionals for a desired outcome.
The world needed more healthcare workers and the WHO anticipates shortfall of over 18 million by 2030.
The world has sought to expedite training of medical professionals by the introduction of cutting edge technology, removal of long standing barriers to traditional medical training and producing quality and well trained professionals in less years to mitigate the growing population needs.
The training of COs/ PAs are directly focused on purposeful relevant clinical training and the elimination of unrelated courses of direct significance to acquiring skillset for practice.
The war is practically unhealthy and can have grave impact on patients’ care. The pluralism in healthcare is evident in yielding good clinical outcomes.
Thank you.
This is very informative to influence policies in different the countries.