Readers React: Poorly trained ‘assistant physicians’ aren’t the answer

To the editor: Can an untrained doctor deliver top-quality primary care after 30 days of supervision in an established practice? I had firsthand experience with partially trained internists while an Army physician during the Vietnam War. I saw some disastrous results. (“Not enough primary-care doctors? Try Missouri’s prescription,” Op-Ed, Aug. 7)

The idea of assistant physicians as health practitioners supervised by a physician miles away frightens me.

We have a shortage of primary-care physicians because they are burdened by an excess of technology (overreliance on tests, billing complexities and poorly designed electronic health records) and inadequate reimbursements. Much of this burden can be attributed to unwanted and unneeded government and insurer regulations.

As with our education system that is failing students, our healthcare system is failing physicians. Assistant physicians are not the answer.

Jerome P. Helman, MD, Venice

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To the editor: As medical director of an inner-city community health center, I understand the difficulty of hiring qualified primary-care providers. However, Arthur L. Caplan’s understanding of medical education is flawed.

Since medical students’ clinical time is focused on hospital patients while primary care is an outpatient specialty, even the best graduating medical student is not ready for the complexity of primary-care patients with a mere 30 days’ supervision.

The consequence of intervention without adequate education on the part of the medical provider has the strong possibility of leading to an outcome worse for the patient than if the intervention had not occurred.

If Caplan really believes that “fairly good primary care” is good enough, I urge him to transfer his own care to a Missouri assistant physician. If he’s reluctant, perhaps it’s because he remembers that, above all, a physician’s duty is to “first, do no harm.”

Deborah Lerner, MD, Los Angeles