I opened the doors to my practice years ago as a solo family
practice doctor.  When I say ‘solo,’ I
mean ‘solo.’  I was the check-in
receptionist, the medical assistant, the physician, the check-out receptionist,
the office manager and the billing department. 
Since then, I have brilliant staff filling each of these positions and added
some more.  Some of the most important
additions to my team are midlevel practitioners.  Physician assistants and nurse practitioners,
as they are more commonly known, have long been involved in helping physicians
take care of patients in a meaningful way. 
However, many times, I come across a certain snobbery that disturbs me
tremendously.  Patients, without meeting
a physician assistant or nurse practitioner, impart judgment about the quality
of care they will receive from a ‘sub-MD’ provider.  Could they be right?  Are ALL doctors better than ALL midlevel
practitioners?  If yes, then it makes
complete sense to ask for “The Doctor” at all times.  Obviously, I think this is absurd as a
scientist and card-carrying member of the Society of Logic!!!  You cannot judge a person’s abilities by the
initials behind their name.

I have been in the company of Great Physicians, those that
are continual students of the human body and the human existence.  These physicians comb the literature and
research journals looking for the best practices and evidence available to help
their patients attain a better quantity and quality of life.  Interestingly, most of a physician’s training
is done in medical school and residency training.  This might be a 7-11+ year process depending
on the medical specialty a physician chooses. 
However, when a physician graduates from the halls of his academic
training hospital, the burden of continuing his medical education falls back on
himself.  For example, Dr. Oldschool
graduates in 1980 from a prestigious medical school or residency.  If he then chooses to ‘just get by’ with his
requirements to maintain his physician licensure, he may never critically
analyze new information and incorporate it into his patient care process.  Said differently, the patients he sees in
2010 might not be getting the robust evaluation and treatment available to them
by the latest evidence-based medicine.  To
make things even more complicated, a majority of the post-graduate physician education
is given by pharmaceutical industry representatives.  Although, I am appreciative of their
knowledge of the new research and new classes of medications they have to teach
me about, I am a New York skeptic and question the impartiality of the information
being presented (especially as I am analyzing the data on behalf of my
suspicious patients).

Now, let’s take the example of Dr. Renaissance.  He also graduates in 1980 from the same
well-respected medical school and residency program.  However, upon graduation, he not only listens
to what the ‘reps’ teach him; he scientifically analyzes it for its use in his
patients.  He keeps current on his
Academy’s recommendations (e.g. American Academy of Family Physicians for my
specialty); he listens to his patients’ contributions about disease patterns
comparing them with other similar patients for more clues on cause and effect.  All the while, he goes above and beyond to be
a patient advocate and supporter.  Of
course, this same example can be made about any occupation, but doesn’t it seem
especially important for those professionals in charge of steering the future
health or demise of your body?  So, I
argue, a physician stuck in old information or slow to accept new information
is not who I would demand to guide my healthcare decisions, even if he is “The
Doctor.”   Based on the stories I hear, I
would easily bet that each one of you has or knows someone who has a ‘bad
doctor’ story that comes to mind within 60 seconds flat.  I hear them all the time.  That’s why I don’t understand why people don’t
entertain other potentially capable providers knowing this common issue exists
everywhere.

Follow me now to my next point.  An experienced Dr. Renaissance-like PA or
Nurse Practitioner would absolutely be worth my time and energy.  If she were led by a Dr. Renaissance that
built his office on good science, good compassion and best care practices, I
would be even more comfortable that I was getting good care.  Karen (our office Physician Assistant) and
Robin (our office Nurse Practitioner) exemplify the standards of quality
patient care and could likely win a clinical showdown with many primary care
physicians.  I am proud to support these
individuals in our office as the organizations that train them are built upon
the very premises that Integrative Medicine strives to add to the current
medical model.  PA’s and NP’s add the
humanity component, the psychosocial factors, and the ‘holistic’ foundations of
what medicine was originally built upon hundreds of years ago.   Actually, I have found as a group, they are much more likely to be interested in Integrative Medicine than physicans on the whole.  As a conscientious Integrative MD who hand
picks the people she entrusts with her patients, I am proud of the type of providers
on my team.  They choose to do extra
reading, extra thinking and extra everything to improve their quality of care
for patients… that’s who patients need on their side.

As for me, my vision still remains clear- to provide the
amazing benefits of Integrative Medicine to the many people of my community and
beyond… to you.  I am eternally grateful
for Karen, Robin and all my dedicated staff who work tirelessly to make this
possible.  In this current healthcare
culture that doesn’t always comprehend the exponentially increased amount of
effort it takes to pioneer and provide this type of meaningful health care, I
applaud any physician, PA or NP who takes this challenge on and does it well.  I look forward to a day where the hierarchy
of medicine degrades and value is once again placed upon knowledge, scientific curiosity,
and compassion- not just initials and rank.