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Re: IUD and PIDFrom: Robert J. Woolley (wooll005@tc.umn.edu)Sat May 29 11:56:25 1999
In message <v03007801b375769a1697@[208.2.63.42]> writes: Is it > at all possible that the public good is better served by insuring that > those who care for the health of our population have been adequately > trained? Sure, and as the saying goes, it is *possible* that monkeys will fly out of my butt. The question is whether you can demonstrate that (1) restrictive practice laws and licensure actually do improve the health of the citizens generally, and (2) whether the increase in costs and decreases in availability of providers that inevitably result from such laws are justified by the alleged benefits. I do not know that anybody has managed to do either of these things.
> Ahem. Count me out of the latter consensus. This is a technical skill that could be learned by anybody willing to invest the time--NP, PA, chiropractor, Army medic, etc. Naturally, it will take more time to adequately learn the necessary skills for one who has not had the broader and deeper general background of med school. But nothing conceptually stands in the way of their gaining the necessary knowledge and skill outside of a formal medical school/residency. I, for one, have worked with surgical assistants who have been doing their job for so long and with so many surgeons that they could easily perform singlehandedly most of the routine cases on which they now merely assist.
The problem is that in
> between are the grey areas. This is the battlefield. Interested parties It seems inevitable that your reason for this is that you think you know what is better for your neighbor than he does. I find this attitude condescending and demeaning, no matter how well-intentioned. If you genuinely trusted your fellow citizens to be capable of figuring out who is best qualified to care for them, and genuinely thought that you have superior training and skills, such that rational people would voluntarily choose to see you and your peers rather than non-MDs, then you wouldn't feel the need to *force* that choice on them by law. Your insecurity is showing. I choose to believe that most people will most of the time continue to choose voluntarily to seek care from appropriate providers. I, for one, am not worried about the competition, and don't feel a need to enforce a medical monopoly, as you apparently do.
> Then you are naive. *Everybody* who seeks to force people to choose *their* services (1) claims only to be working in the public interest, and (2) is actually working in self-interest. This occurs with, e.g., carpenter's unions that try to make it illegal or impossible to hire non-union members to build your deck, or day-care businesses that want to require state licensure to nudge out of the market those who provide such care in their homes casually.
Do we really want to go down that
> path? Would it not be possible one day, due to cost cutting measures, that I do not believe that an insurer, which has to worry about liability for contracting with incompetents, would knowingly allow that.
Do we not owe it to the greater good to fight these battles
> rather than succumb to the harsh Woollian rhetoric? Do we benefit from the Then why are you so afraid that, when genuinely given alternatives, people will flock away from you?
To passively sit back and let our realm be
> invaded by less qualified alternatives is derelict. I'll patiently await your empirical evidence that the current system's benefits outweigh its costs. ---------------------------------------------------------------------------
--------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota
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