“THERE IS NOTHING PERMANENT EXCEPT CHANGE” - HERACLITUS
DR. NOBLE GAVE THE FOLLOWING ADDRESS BEFORE THE 2022 HOUSE OF DELEGATES IN BATON ROUGE. practice of medicine by unqualified providers. There is a stark difference in education between physicians and non-physicians. Some legislators have attempted to negate this argument, but we must never allow this fact to be circumvented or denied. The same medical schools educating our students must stand up for their mission and market their value; otherwise, they risk their existence. Education really does matter! “Winston Churchill was known for his spry humor and his many quotes. Regarding speeches he said that a good speech should be like a woman’s skirt: long enough to cover the topic and short enough to create interest. I will try to adhere to those principals today.
In a similar way, Heraclitus was a Greek philosopher who lived about 500 years before the birth of Christ. Two quotes attributed to him are as relevant today as they were then. He stated, “There is nothing permanent except change,” This medical society was established in 1878. It would not be inaccurate to suggest that we have seen dramatic changes in our 144 years of existence. In what was known as the Golden Era of Medicine, we witnessed the invention of antibiotics and vaccines. We saved millions upon millions of lives for a relatively minimal investment. Years ago, patients were admitted to the hospital for weeks for relatively simple surgeries. Today, we can perform heart valve replacement and joint replacement as outpatient procedures-amazing technological advances that have dramatically changed people’s lives. But we now spend billions of dollars yearly on medications with questionable and marginal benefits. Many research projects conducted today are repetitious and of dubious value. Evidence-based guidelines are currently utilized and touted by so-called experts as a way to ration care by subverting the physician’s judgment, education, and intuition. We have seen significant expansions in the scope of practice of non- physicians under the guise of improving access to rural healthcare and the fallacy of cost reduction. Our senior citizens and the physicians that treat them are locked into an anti-free market system called Medicare that fixes the fee schedule. Regretfully, even France has a better payment system more aligned with capitalism and the free market. Our reimbursement is dictated by insurance companies that have monopsonies across the country. The profession we love and honor is attacked daily by state legislatures around the country. Even in the halls of Congress, we see bills threatening physicians’ livelihood. The greatest threat to our profession is legislation passed in state capitals around the country that permits the independent
In many cases, we are learning that corporations and private equity groups initiate scope of practice battles to drive business to its stores solely for profit, often disregarding safety and best practices. They employ allied health professionals, pharmacists, and mid-level providers and shockingly offer no oversight. Harrison’s Textbook of Internal Medicine was the Bible of our profession for generations. Today the Excel spreadsheet is the guide for corporate healthcare. We should urge the Louisiana Department of Health and our State Board of Medical Examiners to look into these arrangements. Quite simply, this state should forbid the corporate practice of healthcare. In the mid-1970s, we expanded the physician team to include mid- level providers. This strategy works relatively well when deployed correctly. Most mid-level providers are happy to be part of a physician-led team. From a personal perspective, I am fortunate to work with mid-level providers who are an essential part of my team and provide excellent service to my patients. Recently we have seen various groups of practitioners attempt to practice medicine independently. Only a tiny minority, however, is lobbying for complete independence. In some cases today, we see mid-level providers practicing in a different field of medicine than their collaborating or supervising physician. The most absurd example I have seen is a cardiologist collaborating with a nurse practitioner who performs facial cosmetic injections. We now see mid-level providers advertising specialty services without reference to a supervising or collaborating physician.
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J LA MED SOC | VOL 174 | FALL 2022
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