There’s recently been an interesting and sometimes intense debate in legislatures and on social media about the various roles of health care providers. Many physicians refer to it as scope creep. Here’s how it’s going down.
Some nurses’ aides want to do the jobs of licensed vocational nurses (LVNs).
Some LVNs want to move into the care typically reserved for registered nurses (RNs).
Some RNs want more independence so they can practice like mid-level providers, including physician assistants (PAs) and nurse practitioners (NPs).
And, of course, many certified registered nurse anesthetists (CRNAs) contend that they provide better anesthesia care than physician anesthesiologists, so they’re lobbying for completely independent practices without any kind of medical supervision or direction.
Speaking of the term mid-level providers, some PAs, NPs, and certified registered nurse anesthetists (CRNAs) bristle at that term.
There is, in fact, a big debate about what to call these providers.
Some physician assistants want to change the name of their title to physician “associate.”
And then there are those PAs, NPs, and CRNAs—none of whom went to medical school—who earned doctoral-level degrees in their fields and find it insulting to be called anything other than “Doctor.”
This raises some ethical questions for the health care industry. Three immediately come to mind.
Do you think that any of this might be confusing or misleading to patients?
Do you think that patients have the right to know the educational training and experience of the individuals involved in their care?
Do they have a right to choose based on an honest disclosure of information?
I want to add into the mix a fiction of Texas law called the corporate practice of medicine doctrine. Hospital billboards dot the Texas urban landscapes like bluebonnets do the rural ones. In their advertising, hospitals don’t tout how they have the best nurses, therapists, and cooks, but those are the types of employees for whom hospitals are responsible.
Texas law treats physicians as independent contractors. Independent contractors aren’t employees. They’re like the vendors in kiosks in the shopping mall corridors. But patients looking at Texas hospital advertising are reasonably misled into believing that the hospitals also employ doctors. The corporate practice of medicine doctrine creates a system of limited accountability, and that impacts patient safety in a negative way.
I predict that scope creep won’t go away. In an environment like Texas where tort reform flourishes, insurance companies and administrators have a financial incentive to allow less expensive health care professionals at levels beyond their training.
With all of the very political debate on scope creep, I’m afraid that some people have lost the focus on the importance of one indispensable part of the health care team—the patient.
As a patient, you’re entitled to ask questions and to have them answered.
When you meet new health care professionals for the first time, ask them to disclose their profession. If the answer is “doctor,” don’t stop there. Ask if he or she is a physician. Consider asking if a physician is an attending (fully trained) or a resident or fellow (still in clinical training).
Regardless of whether it’s a physician, NP, PA, or CRNA proposing to become involved in your health care, you may want to inquire about when the person finished school and training, how familiar he or she is with your condition, and similar questions.
If you’ve been seriously injured because of poor health care provided by any type of healthcare professional or hospital in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.
