When facts become 'arrogance': Physicians push back against political theater

Physicians don’t show up to legislative hearings expecting applause. In fact, most arrive knowing the vote may already be decided. They come anyway — on their own time, at their own expense, often canceling clinics or trading call shifts — because patient safety is worth two or three minutes at a microphone.

What they don’t expect is to be personally attacked for telling the truth.

Yet that is exactly what happened during a recent Florida legislative hearing on a bill that would allow psychiatric mental health nurse practitioners to practice independently without oversight by a psychiatrist. After calm, evidence-based testimony from multiple physicians outlining differences in training, patient safety risks and noncompliance with existing law, the bill sponsor closed not by rebutting the data, but by attacking the physicians themselves.

They were described as “arrogant,” “obnoxious” and “greedy.” The sponsor claimed doctors were profiting off nurse practitioners, earning thousands of dollars per month per clinician, joking that physicians could use the money to “buy a plane and go to the Bahamas.”

It was not a debate over policy. It was political theater, and physicians were cast as villains for refusing to play along.

The narrative is familiar — and effective

For physicians who engage in advocacy, this script is not new.

The narrative is simple and emotionally compelling: hardworking nurse practitioners versus elitist physicians protecting their turf. It is repeated so often that it becomes an accepted truth even when it is factually wrong. When physicians challenge scope expansion bills, they are accused of arrogance. When they cite differences in training, they are accused of condescension. When they warn about patient safety, they are accused of greed.

This framing works because it shifts the conversation away from evidence and toward motive. If doctors can be portrayed as self-interested, their data can be dismissed without engagement.

What is rarely acknowledged is the irony: Physicians are attacked for arrogance precisely when they are being careful, restrained and factual.

What the physicians actually said

The testimony that triggered the bill sponsor’s outburst was notably measured.

Vicki Norton, M.D., FAAEM, an emergency physician and president-elect of the American Academy of Emergency Medicine, addressed three points: training, patient safety and compliance with existing law. She noted that psychiatrists complete approximately 15,000 hours of supervised clinical training before starting independent practice, often followed by additional fellowship training to care for children and adolescents. In contrast, psychiatric nurse practitioners may complete as few as 500 clinical hours, including only 100 hours caring for children, yet are certified to treat patients across the lifespan.

She also noted that some psychiatric nurse practitioner programs allow 100% of clinical hours to be completed via telemedicine.

“These pathways are simply not equivalent,” she said. “And they can lead to poorer quality of care for some of Florida’s most vulnerable patients.”

To put the numbers in perspective, Norton pointed out that dog grooming certification requires approximately 600 hours of training — more than the minimum clinical hours required for psychiatric nurse practitioner certification.

The reaction was swift and hostile.

When facts become “obnoxious”

Norton drove seven hours each way from South Florida to Tallahassee to deliver two and a half minutes of testimony. She did so knowing the bill was likely to advance. What surprised her was not the disagreement but the intensity of the personal attack.

“It didn’t feel good,” she later reflected. “It was infuriating. But at the same time, I try not to take those kinds of comments personally. I know it’s a game.”

Physicians who have spent time in advocacy often come to the same conclusion: These moments are not about persuasion. They are about reinforcing a narrative for colleagues and constituents watching from the sidelines.

“It’s theater,” Norton said. “They have to sell the story that it’s arrogant physicians versus poor, hardworking nurse practitioners. But that story isn’t true — and it isn’t about patients.”

Advocacy is not a turf war

Ankush Bansal, M.D., FACP, FACPM, SFHM, an internal medicine physician and hospitalist who testified at the same hearing, emphasized that point directly. He works daily with nurse practitioners and values their role on the care team. But, he explained, teamwork does not mean interchangeability.

Physicians complete a minimum of 11 years of education after high school and accrue at least 12,000 clinical hours before independent practice. Psychiatrists complete even more. That training matters — not because physicians are superior people, but because complex patients require deep expertise.

Bansal challenged the idea that workforce shortages justify lowering standards of care.

“Why should a patient in a rural or underserved area see someone with less education and experience than a patient in a wealthier area?” he asked. “That’s not equity. That’s a double standard.”

His closing analogy was blunt but effective: Would lawmakers allow a paralegal to practice law independently? Would they allow a flight attendant to fly the plane?

The response was not to answer the question, but to question the character of the physician asking it.

The cost of speaking up

Across the country, physicians report similar experiences. In South Carolina, doctors advocating for physician-led care have been accused of “protecting turf.” In committee hearings, physicians have been interrupted, talked down to or dismissed with casual remarks that minimize their expertise.

Phil Shaffer, M.D., a radiologist who testified about the lack of data supporting unsupervised practice, was told by a legislator that artificial intelligence would soon replace him anyway.

“It’s easy to think medicine is simple,” he later observed, “if you’ve never practiced it.”

These interactions are not just demoralizing. They send a clear message to other physicians watching: this is what happens when you speak.

For many, that message is enough to keep them silent.

Why silence is the greater risk

Physicians are not trained for politics. They are trained for humility, collaboration and evidence-based decision-making. Those qualities serve patients well, but they are often liabilities in a political environment that rewards certainty over nuance and narratives over data.

Mayes DuBose, M.D., past president of the South Carolina Medical Association, has seen this firsthand. “Humility is not our friend on this front,” he said. “I think people respect physicians, but they don’t understand how much training physicians actually have.”

That misunderstanding fills the vacuum when physicians step back. Policy makers hear from lobbyists and trade groups, but not from the clinicians who bear responsibility for outcomes.

“When physicians avoid this space,” DuBose said, “we’ve done ourselves a disservice.”

The myth of the greedy doctor

Perhaps the most damaging accusation leveled against physician advocates is greed.

The claim that physicians earn thousands of dollars per month per nurse practitioner in “supervision fees” is not only misleading — it ignores reality. In most hospital and employed settings, any oversight requirements are imposed by institutional bylaws, not negotiated by physicians. Physicians often assume additional medical-legal liability for supervision without additional compensation and with little say over hiring decisions.

Bansal noted that in every hospital where he has worked, physicians are still required to oversee nurse practitioners, even in states that allow independent practice. “I’m seeing the same patients,” he said. “I’m reviewing notes, writing addenda, carrying the liability.”

The idea that physicians are profiteering from this arrangement does not align with the lived experience of most clinicians, yet it persists because it is politically convenient.

Why physicians still show up

Despite the personal attacks, every physician featured in this episode came to the same conclusion: showing up still matters.

Not because it guarantees victory, but because silence guarantees defeat.

Advocacy does not always look like public testimony. For many physicians, especially those employed by large systems, speaking publicly carries real risk. But advocacy can begin quietly: a meeting with a legislator in a district office, a phone call, an email or support of medical societies and PACs that amplify physician voices collectively.

“Not everybody can be vocal,” Norton acknowledged. “But if you can’t testify publicly, you can still meet legislators one-on-one. Those conversations are often more productive than hearings.”

Bansal echoed that advice: “Pick one issue you see in your everyday practice. Start local. Most of the time, people will disagree respectfully.”

Collective voice matters

Several physicians emphasized the importance of organized medicine — not as bureaucracy, but as protection.

Not every physician can afford to advocate independently. Employment contracts, nondisparagement clauses and institutional politics create real constraints. Medical societies provide a way to participate without standing alone.

“If you don’t want to personally do it, you need to support the people who are willing and able,” DuBose said. “That collective voice matters.”

For physicians who feel burned out, powerless or resigned to “learned helplessness,” advocacy can be an antidote. It reframes frustration into purpose and reminds physicians that they are not alone.

Advocacy is part of the oath

Being labeled arrogant for stating facts is painful. Being accused of greed for advocating patient safety is infuriating. But those attacks do not negate the responsibility physicians carry.

The physicians who testified in Florida and South Carolina knew they might lose the vote. They showed up anyway. They did so not for recognition, not for profit and not for power — but because patients deserve policies grounded in reality, not rhetoric.

When facts are dismissed as arrogance, the solution is not silence. It is clarity, persistence and solidarity.

Because the greatest risk to patients is not that physicians speak up, but that they stop speaking up.

Rebekah Bernard, M.D., is a family physician in Fort Myers, Florida, and the author of two books on scope of practice.

Music Credits

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Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Florida legislator’s closing remarks attacking physician testimony

0:24 – Episode introduction: Physicians speak out against unsupervised psychiatric nurse practitioner legislation

1:38 – Vicki Norton’s committee testimony on training differences and patient safety

4:23 – Interview with Vicki Norton: Reaction to lawmaker’s comments

7:22 – Introduction of Ankush Bansal

7:57 – Ankush Bansal’s testimony on physician education, ethics, and access to care

9:58 – Ankush Bansal reacts to the sponsor’s personal attacks

13:32 – Introduction of Mayes DuBose (South Carolina advocacy effort)

13:57 – Mayes DuBose on physician image, humility and legislative communication

15:11 – South Carolina “turf war” characterization

15:43 – Mayes DuBose describes committee hearing experience

16:02 – Phil Shaffer testifies on lack of data

16:18 – Legislator comments about AI replacing radiologists

16:42 – Phil Shaffer responds to AI comment

18:27 – Florida bill sponsor closing remarks (“It’s going to be cool”)

19:06 – Phil Shaffer on legislators’ understanding of medicine

19:46 – Call to physician advocacy

20:34 – Vicki Norton on overcoming personal attacks and getting involved

22:48 – Ankush Bansal’s advice for physicians interested in advocacy

23:43 – Phil Schaefer on why physicians struggle to engage politically

24:33 – Mayes DuBose on supporting organized medicine

26:05 – Mayes DuBose on collective voice and combating learned helplessness

28:20 – Final encouragement to join local and state medical societies

29:02 – Closing remarks from host Rebecca Bernard