Residency where doctoring learned

Letting medical school grads go straight to practice a bad idea

My response to the story “Laws to ease doctor shortage see lag,” in the Albuquerque Journal on Dec. 14, is amazement. It constantly confounds me when good doctors become politicians and instantly forget how to be good doctors, meaning they cease to be good problem solvers.

Dr. Keith Fredrick, an orthopedic surgeon and state representative in Missouri is a perfect case in point.

This fully trained, highly experienced doctor sponsored a bill that became law in Missouri called a “first–of–its– kind solution to the physician shortage plaguing thousands of U.S. communities.”

Unfortunately, this terrible first–of–its–kind is not the only–of–its–kind. Neighbors Arkansas and Kansas have also passed similar, equally ill-conceived laws.

Frederick’s law basically says that someone who graduates medical school can go out immediately and practice medicine on people without “working through years of traditional residency (training).”

The implication is that all those years of pesky postgraduate training are not truly necessary.

Anyone who is a fully trained, experienced physician — and not a politician — knows that when you graduate medical school, you have lots of theoretical book learning and are not yet competent to function as a quality or even safe caregiver.

You have no judgment. You don’t know how to practice medicine — yet — only how to think about medical problems and answer test questions.

I must say with all candor that I would have been dangerous to my patients if I had practiced medicine on them the day after I got my M.D. degree. Every honest physician, anywhere, would say the same thing about himself or herself.

Frederick’s law seems to recognize this practical deficiency by licensing these untrained graduates to provide “only primary care services in ‘medically underserved’ areas as long as they are supervised by another physician.”

There is a name for care providers who are supervised by physicians. They are called nurse practitioners.

Nurse practitioners are trained for practical medicine and not for theory. They provide an invaluable service.

Nurse practitioners know what they know and more importantly, they know their limits — and so do the patients.

Untrained physicians are not the same as nurse practitioners.

The former are likely to make mistakes through inexperience that the latter nurse practitioners would know to avoid.

Even more worrisome is the limitation to “medically underserved” areas.

Patients who live without readily accessible medical services typically have not had routine or preventative care. They are sicker and more complex than others and require the highest level of experience, not the lowest.

Jeff Howell, government relation’s director for the Missouri State Medical Association, spoke glowingly about the early licensing law, saying, “It kind of allows us to be a trailblazer on the issue.”

Missouri may be blazing a trail but the trail they are blazing leads to medical malpractice court.

Given the number of avoidable adverse effects that are likely to happen to patients because of care given by untrained, inexperienced providers, the early licensing laws in Missouri, Arkansas and Kansas might be called a Christmas present to the Midwest society of medical negligence lawyers.

The Missouri law was passed almost two years ago. To date, not a single medical school graduate has taken advantage of early licensing.

I wonder if these newlyminted doctors have more sense than the older physicians–turned–politicians.