Page 27 - Layout 1

FEATURE
have committed themselves to. The virtuous mission represents the
bioethical dedication to compassionate caretaking that all health pro-
fessionals must learn to value above their own private interests in
order to maintain the highest standards of care.
The Association of American Medical Colleges advises that com-
pensating for the national shortage of physicians will require “effi-
cient use of all health professionals on the care team.” [2] Addressing
this issue on a worldwide scale has produced an unprecedented surge
of hybridized care teams. [3] For the purpose of ensuring the effec-
tive flow of patient information and clinical tasks, it is now more
important than ever to understand the differences between physi-
cian-level and mid-level practice. Mid-level health workers have been
successfully taking care of patients around the world for over a cen-
tury. [4] Various categories of these professionals exist today with
different amounts of medical education and certification. These
workers are generally trained in history-taking, patient counseling,
performing physical examinations, and/or prescribing medication.
Although their scope of practice is generally narrower than that of
physicians, they widely render autonomous health services and
thereby partially alleviate the burden of physician shortages. Accord-
ing to the U.S. Bureau of Labor Statistics, these workers constitute
over half of the entire national healthcare workforce. [5] Their pro-
liferation has reshaped the modern clinical environment.
The conflict between health practitioners of different levels is
born partly from the belief of some doctors that the relatively lesser
extent of mid-level educational training should subjugate mid-level
providers to physicians when it comes to clinical decision-making.
Another cause of animosity that can arise from physicians toward
other providers is the perception that mid-level care diminishes the
patient-doctor relationship by usurping physician responsibilities.
This worry of some physicians may extend to concerns about the
patient-doctor relationship being so disrupted that it is eventually
rendered obsolete. [6] At the same time, mid-level practitioners do
not always take kindly to being viewed as inferior caregivers. The
American Academy of Nurse Practitioners has repeatedly con-
demned the use of terminology such as “non- physician provider”
and “allied-health provider”, citing derogatory connotations that do
not reflect the advanced care delivered to patients on a daily basis
by licensed mid-level practitioners across the country. [7] These are
some of the main sources of conflict among healthcare providers
with differing credentials attempting to care for the same patients.
In light of these competitive tensions, it is important not to forget
that taking proper care of sick individuals is the common, utmost
priority of healthcare teams. The utility of mid-level health workers
in facilitating the clinical duties of the physician is undeniable in this
endeavor. Consider a patient with sickle cell disease. The care of this
patient will typically involve nurses, nurse practitioners, respiratory
therapists, social workers, and counselors managing the difficulties
of caring for a child with a chronic illness. Having these colleagues
available to attend to various duties can enable the physician to direct
highly-organized patient management.[8] On the other hand, a sense
of entitlement to decision-making regarding patients will only brew
discontent between providers with overlapping job descriptions.
Physicians and mid-level health workers should instead strive for
gratification by realizing that synchronizing their efforts provides
quality care that is greater than the sum of its parts.
Neutralizing competitive attitudes between doctors and mid-level
providers is necessary to promoting “well-being for all at all ages”
by the year 2030 as outlined in the United Nations Sustainable De-
velopment Goals. [9] Mid-level health services are widespread and
provide patients with more healthcare options in addition to facili-
tating physician duties within integrated settings. Multidisciplinary
collaboration within patient care should be viewed as an opportunity
to optimize the quality of medical services rather than being dwelled
upon as an impediment to further clinical advancement. As health-
care workers our goal is to promote the general welfare by ensuring
that our patients receive optimal medical attention. Accomplishing
this objective will be our collective contribution to improving the
standards of living for those in need. This includes the resolution
of occupational disputes that run counter to our common goal by
adversely impacting the quality of care provided. Integrated clinical
environments may cause health workers to lose sight of the specifics
of workplace roles, but the virtuous mission of healthcare renders
this concern trivial compared to whether or not patients are being
properly attended to. The true caregiver is the individual that safe-
guards health interests of patients - regardless of his or her degree
of educational achievement – as dictated by the basic bioethical prin-
ciples of autonomy, beneficence, non-maleficence and justice. Physi-
cians and mid-level providers should therefore always aim to uphold
the virtuous mission of healthcare. In an era where healthcare is con-
stantly evolving to meet the needs of patients, the virtuous mission
will ultimately guide humanity to the rescue.
Ammar N. Saigal is a fourth-year medical student who is cur-
rently studying to become an Orthopaedic Surgeon at the UT Health
San Antonio Joe R. & Teresa Lozano Long School of Medicine.
continued on page 28
visit us at www.bcms.org 27