Obligation vs. integrity
Other vulnerable patient populations are being affected by physician replacement. Shannon Mitchel, MD, a wound care specialist, describes losing her job providing care to patients at skilled nursing facilities (SNF) because she refused to sign off on midlevel charts without adequate supervision. “My contract required me to supervise a physician assistant (PA) and two NPs,” she explained. “These were all new graduates who were given a two-day course on wound care and then sent off to work independently at different SNFs. But I was given no time to supervise or train them.”
When Mitchel followed up on one patient that one of her NPs had seen and realized that the care had not been medically appropriate, she was deeply concerned. “These patients in SNFs often have dementia or other conditions that don’t allow them to speak for themselves, and I couldn’t allow this kind of care to happen to them on my watch,” she said.
Ultimately, Mitchel found herself at an impasse. “I was obligated by the nature of my employment to sign-off on NP charts, but my integrity would not allow me to do it unless I was truly allowed to supervise in a meaningful way and not just ‘signing-off’.” She left the wound care company but is still struggling to find a job that doesn’t come with similar strings. “Every physician contract I see has a supervision clause built into it,” Mitchel noted.
Physicians, patients, and politicians need to know what is happening. Physicians are willing and able to care for the underserved, the needy, and the vulnerable. But we are being replaced by lesser trained providers to save a few dollars – which is likely to be a short-term cost savings at best. How much will it cost our society when patients, especially our children, grow up without adequate treatment of medical conditions, particularly when they are facing mental health crises? This may prove to be a true national catastrophe.
Editor’s Note: The author spoke with all physicians involved in this blog. All four physicians reviewed the text and approved the details.