By Martha Leatherman, MD, Past President, Texas Academy of Psychiatry
Did I get your attention? It’s a real problem and affects people throughout the country, but the identity theft I’m talking about is the one you’re likely thinking about. The dictionary defines identity theft as “the fraudulent acquisition and use of a person's private identifying information, usually for financial gain.” I would like to propose another sort of identity theft that has been happening in American medicine for at least the last twenty years. It hasn’t made the news; it hasn’t been defined in our common vernacular; it hasn’t been declared a crime. That is because it has been widely accepted as a reasonable evolution of American medicine. The identity theft I’m talking about is the slow creep of para-professionals into the practice of medicine, and the use of the words “doctor,” and “physician” to mean things other than a professional who has devoted his life to studying medicine and has earned an M.D. or D.O.
The identity of “physician” has been stolen by the bureaucrats, the insurance companies, the legislators, and the special interests. We are now “providers” along with other “providers” such as acupuncturists, midwives, phlebotomists, and nurse aides. Often, these other providers allow patients to call them “Doctor.” Physicians graduate from medical school with tens of thousands of dollars worth of debt, heavy malpractice premiums, and expectations of perfect performance, but are paid not much more than the nurse practitioners they work alongside.
In another life, probably during the days of dinosaurs, physicians administered injections, drew blood, performed EMGs, and took vital signs. Now, many physicians do not even take a history from their patients. Increasingly, nurses and nurse practitioners counsel patients, perform procedures, take histories, write prescriptions, and make “diagnoses.” Nurse aides answer medical questions and perform minor procedures. Patients increasingly feel that they are getting their real medical care from paraprofessionals, and that the actual physician is little more than a figurehead. Physicians are boxed into algorithmic medicine and are required to follow the flowcharts devised by bean counters who are more interested in demographic outcomes than in what is best for an individual patient. Our work is digitized, analyzed, and criticized, but no one has ever captured the art that is medicine, and in trying, they are turning us into technicians.
This is identity theft. The professional identities of thousands of physicians have been stolen, and we have been left with identities we never wanted. The stereotype of a medical school applicant’s answer to “why do you want to be a doctor?” was always “because I want to help people.” It’s a stereotype because it was true of so many of us, and by “helping people,” we meant getting to know them and their families. We meant having our patients bestow on us a level of trust and caring that few are privileged to share with anyone. The television character Marcus Welby, M.D. is an icon because his character represents something that people long for, but now rather than being seen as helping, caring, professionals, we hear patients complain that “the nurse did all the work” and “the doctor spent less than three minutes with me.”
What does this have to do with the Texas Academy of Psychiatry? The Academy, along with our colleagues in the Texas Society of Psychiatric Physicians and other member organizations of the Federation of Texas Psychiatry have consistently worked to protect the professional identity of Texas psychiatrists. From the halls of the Capitol building in Austin to the bowels of regulatory agencies and insurance commissions, members of organized psychiatry work to protect physicians and our patients from expanding scope of practice by non-physicians as well as from the practice of medicine by legislative fiat. The Texas Academy of Psychiatry remains a professional organization of physicians who work together to network, educate, and support each other as we navigate the changing landscape of medical practice today.
We need your support to continue our work. Obviously, we have a lot to do and a lot to learn. Please join us.
This article appeared in the February/March 2014 issue of Texas Psychiatrist. Reprinted with permission.