A Plea for Transparency in Medicine
The Pennsylvania Medical Society has taken a clear position in focusing on transparency not only in terms of health care costs but also on the mid-level providers’ training. They take about 20 times less in training hours than physicians. Patients have a right to know who is taking care of them as well as the level of training of the provider.
The Pennsylvania Medical Society has been outspoken in opposition to the unsupervised practice of mid-level providers. The primary argument raised has been based on differences in the amount of clinical training, between physicians and mid-level providers, with physicians logging about 20 times as many hours of training by comparison.
One aspect of this debate that has not been emphasized is the transparency issue. Transparency has been a focus at the national level in terms of health care costs, but transparency is also important in the context of scope of practice. Patients should have a right to know who is taking care of them as well as the level of training of the provider, be it physician, nurse practitioner ( NP) or physician assistant (PA). As an example, how many Doctors of Nursing Practice (DNP’s) who introduce themselves to patients as “Doctor” will actually explain to their patients that they are not medical doctors despite the fact that they would be practicing medicine?
Another example of this has occurred at a local hospital where administrators have decided to change their surgical on call staffing. According to an opinion piece written by a board member of Physicians for Patient Protection, this hospital previously had surgeon hospitalists, i.e physicians, on call at the facility overnight to address any emergent surgical needs or acute post-op complications. In their new business model, the hospital has determined that PA’s despite less training than these physicians, will be addressing acute surgical issues occurring after hours in the hospital setting, while surgeons will take call from home. The obvious concern here is patient safety as these patients will now be immediately tended to by those without the same level of surgical expertise. The question must be asked as to whether these PA’s will have the training and experience to adequately address emergency post op issues?
However the issue of transparency is also important. Will patients know that their overnight coverage is not from an in house physician? Will individual patients be made aware of this before they schedule elective surgery at this facility? Will they have a choice?
While hospitals and other facilities that provide health care, including doctors’ offices, absolutely have the right to design their own business models, it is imperative that individual patients be made aware of the model used at a particular facility. They need to know whether it will be a physician or someone with considerably less training who will be addressing their problem. For many issues, PA’s and NP’s are perfectly capable of providing the proper care, but patients need to have a choice.
Health care is the only field of endeavor where a consumer purchases a service prior to knowing the cost they will pay for that service. Must they also be blind to the experience and training of the entity providing that service?
Transparency is critical in all aspects of health care.
Source: Bucks County Courier Times