Author + information
- Kenneth Stone, MD∗ ()
- ↵∗Department of Anesthesiology, Bridgeport Hospital, 267 Grant Street, Bridgeport, Connecticut 06610
I read with interest the letter from Drew et al. (1), which commented on the suspected shrinking pool of cardiologists who are willing and able to read the standard 12-lead electrocardiogram. They suggested that nurse practitioners should be trained to perform this task. In the same issue of the Journal, Drs. Patrick T. O’Gara and William J. Oetgen, writing as leaders of the American College of Cardiology (ACC), published a statement on behalf of the ACC Executive Committee and Board of Trustees in which they addressed the concerns held by many ACC members regarding the American Board of Internal Medicine’s new Maintenance of Certification requirements (2). Such concerns center on the financial and time burden imposed by the new requirements and question the validity and utility of its demands.
I found the juxtaposition of these two papers to be both serendipitous and insightful. They are reflective of two trends that should be disturbing to the physician community. The first trend is that the practice of medicine is being ceded to nonphysician providers either by choice (as in the proposal by Drew et al. ) or by the design of allied health professionals. There are many clashes regarding scope of practice within the various medical specialties. The field of anesthesiology has been engaged in such activity for years, with certified registered nurse anesthetists (CRNAs) who desire to practice independent of physician collaboration. Lest the majority of members of the ACC believe this to not be a concern of theirs, I call your attention to a policy statement from the South Carolina Nursing Board in 2012 that a CRNA may insert a transesophageal echocardiogram probe in the operating room to acquire and interpret echocardiographic images for surgical decision making (memorandum from Saiza Elayda, Senior Specialist, State Advocacy & Grassroots to ACC Advocacy Steering Committee; FTC Advocacy at the State Level; June 1, 2012).
The second trend is that the various medical board and certification organizations, such as the American Board of Internal Medicine, are increasing the complexity, burden, and cost of achieving and maintaining certification; this is in contrast to nonphysician provider advocates, who are simultaneously lowering the bar to their own ability to mirror the practice of medicine by physicians. Consider the attempt of the South Carolina Nursing Board to simply declare the competency of CRNAs to perform transesophageal echocardiography versus the demanding standards of transesophageal echocardiography certification for physicians by the National Board of Echocardiography.
There is certainly a role for allied health professionals in the medical field, and the collaborative relationship with physicians is productive in proper context. However, physicians must be mindful of the not insignificant efforts to create an impression of equivalency between physicians and nonphysician health care professionals. It does not serve the interests of the medical profession or the well-being of our patients for this distinction to be eroded.
- American College of Cardiology Foundation
- Drew B.,
- Dracup K.,
- Childers R.,
- et al.
- O’Gara P.,
- Oetgen W.