On Physicians Together
Protecting the Professional Identity that Keeps Our Patients Healthy
If a non-physician prescribes a medication that causes harm, or misinterprets a clinical presentation and delays necessary treatment, the impact on the human body is identical to a physician error. Why, then, is the act of medical care held to a lower legal standard simply because of the title of the person who performed it? This regulatory framework functions like holding an interior designer to a lower standard of structural integrity than a licensed engineer when building a skyscraper. The laws of physics do not grant a discount for a semantic technicality; if the structure fails, the wreckage is identical. In a highby Thomas S. Higgins, MD, MSPH, MBA
In the early 20th century, American medical education was fractured and largely unregulated. Training programs operated as independent, proprietary entities with little standardization, ultimately compromising public trust. To address this, Abraham Flexner, a native of Louisville, was commissioned by the Carnegie Foundation to evaluate medical training across North America. His landmark 1910 report radically reshaped the structure of medical education, dismantling substandard schools and anchoring instruction in academic medical centers. 1
This reform not only set academic standards but also forged a cohesive professional identity. Flexner’ s framework established a shared language and uniform benchmarks of excellence. For over a century, this unity ensured that a physician’ s primary loyalty remained unequivocally with the patient.
However, the cohesion of this professional identity has been steadily eroded by shifts in healthcare nomenclature. When Medicare was established in 1966, the administrative need to bill for both physician and non-physician services led to the adoption of the generic term“ provider.” Over the past two decades, what began as a simple billing convenience has evolved into a fundamental clinical crisis. Today, we face a paradigm where practitioners without medical school or residency training seek independent practice, asserting they are operating at the“ top of their license” while bypassing the rigorous, clinically standardized training essential for high-stakes medical decision-making.
This creates an untenable double standard of care. We must ask: how can we justify autonomous, life-altering medical decisions by practitioners whose qualifications rely on a few courses and passive timers that calculate independence based on calendar years rather than on clinical volume or case complexity, instead of the 12,000 to 16,000 hours of intensive residency and fellowship training required of physicians?
When we accept a two-tiered system for independent medical practice, the consequences are predictable. Robust data, including the Hattiesburg Clinic study and National Bureau of Economic Research data from Veterans Health Administration Emergency Departments, consistently demonstrate that independent non-physician providers significantly increase diagnostic over-utilization, unnecessary specialty referrals and overall expenditures, all without improving patient outcomes.
I speak to physicians every day who are deeply concerned by this reality and are ready for change. The patients of our Commonwealth deserve a standard of care that is demonstrably safe and rigorous in practice.
The Illusion of Risk
To understand why professional unity is a prerequisite for patient safety, we must confront the legal and conceptual fictions that have quietly settled into modern clinical practice. Under current state frameworks, non-physicians operate under the jurisdiction of distinct non-physician boards rather than the practice of medicine. Advanced Practice Registered Nurses practice advanced nursing under a nursing board; optometrists provide eye care under an optometry board. Neither group is held to the standards of the physician despite providing medical diagnostic, prescriptive and in some cases, surgical care for patients.
Yet, clinical reality is entirely indifferent to these administrative labels. When a patient presents with a medical issue, the underlying pathophysiology does not alter itself to match the credentials of the practitioner in the room. The diagnostic complexity of an undifferentiated disease, the physiological risks of a pharmaceutical intervention and the potential for catastrophically errant clinical oversight remains absolute.
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