Hello, I am a physician. Who are you?

Many years ago when I embarked on my journey to become a physician, I didn't anticipate practicing medicine in the United States, one day.  My training in the medical school was pretty straight forward, not only in terms of my role and responsibility as a physician, but also regarding the roles and responsibilities of the ancillary team members.  Now over a decade later while practicing in the United States, I find myself in an uncharted territory.  A territory where I have to justify my place as a physician and actively try to keep the scope of practice boundaries from getting blurred, by a slew of political and economical motives.

The ground rule of practicing medicine, "First do no harm.", seems to have become a mere philosophical inconvenience, for everyone else but the physicians.  As if the onslaught of managed care and the increasing regulation, telling me about how I should practice wasn't enough; now I am to welcome with open arms; warmly and happily, the next best thing, or I will be labeled arrogant, angry and an obstructionist. 

Enter the world of mid level non-physician providers and the expectation of the system, that the physicians would and should assimilate.  All this in the name of access, cost, and teamwork.  The political lobbying and the financial investment in the gradual but surefire, decimation of a physician's unique place in health care; is something that I never expected to have to deal with.  

How does someone deal with the indifference of a whole system towards your own existence?  What does one tell the politicians and lobbyist who don't seem to understand that becoming a physician takes years out of an individuals life and is more than just how many number of hours of clinical training one has vs a mid level provider? Where does one draw the line between collegial and advisory relationship with another profession that also threatens and actively tries to devalue your own profession, by assuming a false equivalence not only in scope of practice but in fundamentally trying to change the definition of your hard earned place as a physician?  How does one start a conversation with the agents of change, when citing facts about glaring discrepancies in basic education and competency are deemed, territorial and unproductive?  

The rising cost of health care in the United States, because of the failed system of managed care and divisive politics, has turned the blame somehow on the physicians.  The current environment is literally putting a target on the backs of a profession that takes more than half of our lives to learn, perfect and practice.  

Practicing as a physician in the United States, isn't a walk in the park.  Just because you are done with residency and/or fellowship, doesn't mean you are done.  There are certifications, MOC, continued CME requirements, ever increasing regulatory pressures that claim to reduce physician burden by the way of MIPS or APM, but rarely do.  Despite all the pressures and demands that a failed and overblown system puts on us as physicians, we are supposedly the problem and not the solution.

The push to let more and more mid level providers ranging from CRNAs, to NP, ARNP, DNP, PA, prescribing psychologists and something called Cathopathic Physicians (yes it is a thing and they are still actually NP) the list goes on and on, practice medicine without having the comparable education, training, testing requirements and frankly ability, to do so, is what a healthy healthcare system wouldn't need to do. 

The false logic of cost containment and improved access, falls right on it's face when organizations actually are replacing physicians with mid level providers at steep salaries and/or exuberant contract rates.  This is where the rubber meets the road because the reality is that that most mid level providers don't go to the rural areas to work but actually end up replacing highly trained and specialized doctors, giving patients no choice in the delivery of their care.  

As a physician in this time of existential threat to my profession, I have learned that if we remain complacent to the trend, we will be part of the problem and eventually be decimated by a monster health care system, that is incapable of reigning itself in and defining boundaries for the sake of the patients it is supposed to serve. 

Elevating mid level providers to the level of a physician by allowing unsupervised independent practice, is not the solution for a sick system but rather a recipe for further sickness, only with a steeper price, i.e. patient safety.  Filling the market with inadequately educated and poorly trained providers from online schools and scarce patient contact hours, is not a healthcare innovation for the future but a ticking time bomb of medical negligence.  

So I wake up every morning and get ready to go do what I do best.  Be a physician!!!  

I make a conscious effort to educate my patients about their choices for their healthcare.  And I am ready to ask every day, to whoever will question or dilute the validity of my place in the system as a physician, "Hi, I am a physician, and I am trained to practice independently.  Who are you?"  

Because if I don't step up to save my profession and be blunt about it, no one else will.