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Tue Dec 18 13:03:11 GMT 2007

Don:  Your list of scientific prerequisites would disqualify many of today's medical students -- I spent a year in the medical school at UCSF as part of my graduate nursing training, and at least half of the M1's I was in class with had humanities degrees and their only science was the minimum:  general & organic chemistry, general physics without calculus, and a year of general biology.  I've never set foot in an organic chemistry classroom and did very well in biochem, physiology, histo, cell biology, neuroanatomy, the entire M1 curriculum with the exception of intro to clinical medicine, which would have been pretty redundant. There wasn't a year of biochem at UCSF -- we had one quarter.  Those with undergraduate biochemistry to any extent could test out, and a few did.

I would respectfully challenge your view of nurses as people who are not responsible for our own practice.  Unless a physician also has an RN, in most states s/he could be prosecuted for practicing nursing without a license if s/he attempted to do so.  In that realm my practice is entirely independent.  Only in those areas where I am clearly the physician's designee -- such as first assisting in the OR -- am I not totally and independently accountable for my practice.  In fact, if a physician orders an inappropriate drug or dosage and I, as the RN, administer that erroneous drug or dosage, I am independently legally accountable for that error.

I realize that this will probably not change anyone's bias.  I just want to be accurate for the record.  We are distinct but overlapping professions, just as medicine and dentistry, medicine and psychology, or medicine and social work.  We're all necessary for patient care.  And we're all accountable for our own practice.

Jane Harper, PhD(c), RN, APN

	-----Original Message----- 
	From: trauma-list-bounces at trauma.org on behalf of bensonblues at comcast.net 
	Sent: Tue 12/18/2007 12:27 AM 
	To: trauma-list at trauma.org 
	Cc: 
	Subject: Physician Extenders (OP-ED Page)

	The discourse on physician extenders has been excellent. As a practitioner whose been a medic, nurse, and (eventually) doctor, I have my bias. And, it is my optinion that PAs, NPs, EMT-Ps, et cetera are potentially invaluable at all levels of health care.

	However, any practitioner who has not availed themself to a strong scientific education prior to their clinical training should be supervised by someone who has. What separates the best thinkers from the rest is education: 1 year physics, plus 1 yr inorganic chemistry, plus 1 yr organic chemistry, plus 1 yr biochemistry, plus 2 yrs biology-including genetics and embryology, plus 2 yrs mathematics to calculus, plus what ever the hell your major was...plus 4 yr (classroom, lab, clinic, hospital) medical school, plus at least 3 if not 4 if not 5 if not 6 yrs - of residency training, bla bla woof woof. I'm getting a headache.

	If you've met these requisites, no matter your degree or title, I will believe in and support your practice and its autonomy. If you have not met these requirements, enjoy your status as the person who can point to someone else as being responsible for things when they go wrong, and as someone who can take the credit for things when they go well. You will most likely require less stenting of your coronary arteries, live longer, and end up sleeping with the other fellow's widow.

	DB

	Don M. Benson, DO, FACEP
	Program Director, Emergency Medicine Residency
	St. John Hospital and Medical Center
	Associate Clinical Professor
	Department of Emergency Medicine
	Wayne State University School of Medicine
	Detroit
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