Thursday, March 7, 2013

When is a Doctor not a Doctor?

When I graduated from law school with my J.D. (Juris Doctor) degree, I remember getting a call from one of my smart-aleck brothers. We had another brother with a doctorate in theology, so Mr. Smart Aleck said, “Now we have two doctors in the family and neither one of you is worth a damn.” That might be a debatable point when he needs a lawyer, but he was reflecting a commonly held belief, maybe a bit old-fashioned now, that the only REAL doctors are M.D.s. But these days a whole array of health care providers attain doctorate degrees – most of which (like my J.D.) are non-research professional doctorates. So, physical therapists, pharmacists, and dentists are all “doctors.” But, especially in the field of nursing, the question of who can call themselves doctors has become an even hotter topic.

In my home state of Florida – where you can always count on the most extreme ideas to come from our state legislature – bills have been introduced that would force health care providers with doctorate degrees to explain to patients and the public that they are "not medical doctors" or face felony charges. Yes, that’s right – felony charges!!

The AMA has had a “Truth in Advertising” campaign for several years now. They have data that indicates there is a lot of confusion among consumers of health care as to who the various practitioners are. We in allied health know that this is a problem – everyone who has direct contact with patients is perceived by most patients as either a doctor or a nurse.

So, the AMA’s “model legislation” calls for all health care practitioners who come in contact with patients to wear a name tag “that clearly identifies the type of license held…” This is certainly not a bad thing and it would help promote the visibility of professions like medical assisting. The AMA’s material notes that the model bill “does not provide for criminal penalties.” But it goes on to say, “although a state may wish to pursue that course.” Really? Do we really want to further clog up our criminal courts with felony charges against a nurse practitioner who fails to clearly identify him or herself as NOT a doctor?? Will prosecutors, who are ever sensitive to political concerns, be lobbied to throw these “not real doctors” in the slammer?

For more information on the AMA’s campaign, here is the document I have cited: The AMA says this is not a “turf battle” but others disagree. Here’s an interesting article from Bloomberg that offers another perspective:

Friday, February 22, 2013

State of the Education Union

Education and accreditation leaders were not shocked when, in his State of the Union address, President Obama said this about higher education: “Taxpayers cannot continue to subsidize higher and higher and higher costs of higher education. Colleges must do their part to keep their costs down, and it’s our job to make sure they do.” This is a theme we have been hearing repeatedly from the Administration.

But the “supplemental document,” released after the speech, did contain a very big surprise for the accreditation community. In that document the White House said: “The President will call on Congress to consider value, affordability, and student outcomes in making determinations about which colleges and universities receive access to federal student aid, either by incorporating measures of value and affordability into the existing accreditation system; or by establishing a new, alternative system of accreditation that would provide pathways for higher education models and colleges to receive federal student aid based on performance and results.”

Right now, in order for their students to receive federal financial aid, a college must have institutional accreditation from an agency recognized by the US Department of Education.  (This is different from program accreditation which is what CAAHEP does). The main purpose of the recognition by the Department is to assure that the accreditors are serving as “gatekeepers” for that federal aid. But with rising default rates on student loans and ever-escalating costs for a college degree, the Administration clearly believes that those institutional accreditors are somehow failing in their duty as gatekeepers.

There has been a lot of debate in recent years in the accreditation community about how we should balance our roles as the cop who assures certain outcomes versus promoter of quality and quality improvement. That debate will no doubt continue.

But what is of particular interest to me is that the underlying philosophy in the Administration’s position seems to be that federal money should be used only to train students for jobs. If you want to spend $40,000 on a liberal arts degree that won’t prepare you for a profession, you have that right. But not at taxpayers’ expense.

Many of us in the “Boomer” generation started out with English or philosophy degrees before we ultimately settled into a profession. But given high unemployment rates and the fear of the looming crises over student loan defaults, this would appear in the minds of many to be a “luxury” we can no longer afford.