How Crazy the World Would Be Without Physician Advocacy
by Thomas S. Higgins, Jr., MD, MSPH, MBA
The year is 2026, and I am walking through the halls of a hospital that feels more like a processing plant than a sanctuary for the sick. In this alternate reality, one where we stopped showing up to the statehouse, where we let our medical society memberships lapse and where we allowed the“ corporate noise” to drown out the physician’ s voice, the practice of medicine has become an unrecognizable ghost of its former self. As a fellow physician, I see moral injury and automated indifference in the eyes of my colleagues, and the empty seats become noticeable in medical schools across the country because no one wants to be a physician. It’ s too hard to become a physician, they say. It takes too many clinical training hours to become a physician, they say. The only avenue for physician training to take is to reduce its educational hours, reduce its experience and reduce its quality. This is the world that advocacy prevented, but it is also the world that remains only one legislative session away if we lose our resolve.
Dilution
The very definition of a“ physician” has been eroded in this nightmare scenario. By 2026, the scope-of-practice battles we fought in the early 2020s were lost. Without our constant presence in Frankfort, the lines between thousands of hours of residency and a few hundred hours of online modules were erased by legislative fiat. You might walk into a clinic for a complex neurological issue and be seen by someone with a“ doctorate” in a field unrelated to medicine, yet they are empowered to prescribe, diagnose and even perform minor surgical procedures with zero physician oversight and insufficient training.
In this reality, the“ physician-led, team-based care” model is a euphemism for“ physician-absent care.” We know that when a physician leads the team, outcomes improve and costs drop. But without advocacy, the lobby for lower standards wins. Patients, who often don’ t know the credentials of the person behind the mask, are the ones who pay the price in missed diagnoses and fragmented care. The“ physician-led” banner isn’ t about ego; it’ s about the fact that when things go sideways in the operating room or the ICU, there is no substitute for the depth of knowledge that comes from the traditional medical path.
Criminalization
Fast forward to the year 2050. Kentucky House Bill 159 of 2024, which would make Kentucky the first state in the nation to explicitly decriminalize unintentional medical errors, never passed. The tragedy of the nurse RaDonda Vaught case was not seen as a wake-up call for system-wide safety improvements, but rather as a blueprint for the prosecution of human fallibility. Today, in 2050, Kentucky physicians and nurses do not report“ near misses” or inadvertent errors. They hide them. Because, in this reality, a mislabeled vial or a misunderstood verbal order in the heat of a trauma resuscitation is not a“ sentinel event” for a quality committee; it is a felony.
The culture of safety that we fought so hard to build is replaced by a culture of concealment. When errors are criminalized, the first casualty is the truth, and the second is the patient. Without the criminal immunity for inadvertent errors that we successfully advocated for in 2024, our hospitals would be staffed by the brave and the reckless, while the most meticulous minds flee for fear of the jail cell. We would see a mass exodus of the nursing workforce, and the remaining physicians would practice such defensive medicine that a simple sinus infection would require a dozen redundant, CYA consultations before a single antibiotic was prescribed.
Algorithms
In 2050, the vision gets even darker. The physician-owner, the bedrock of the independent practice, is an extinct species. Medicine is entirely a corporate utility. And health care prices are unsustainable. The stethoscope has been replaced by a“ biometric interface” that patients use at home. If the interface detects a problem, it doesn’ t suggest a doctor; it suggests a subscription tier upgrade.
Without the advocacy efforts of the previous decades to protect the
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