By Sean Wilkes, MD

The healthcare landscape is currently facing a contentious transformation, particularly highlighted by the expanding roles of midlevel practitioners such as Physician Assistants (PAs). A striking instance of this shift is presented on “The Medicine Couch” YouTube channel, where the spotlight falls on Stephen DeVries, a cardiothoracic surgery PA who boldly steps into a domain traditionally reserved for the most extensively trained physicians: performing organ procurement surgeries independently.

DeVries’ actions not only blur the lines of established medical practice but also ignite a fierce debate about the adequacy of midlevel practitioner training, the potential overreach of practice scopes, and the ethical implications of entrusting such critical surgical procedures to individuals whose training pales in comparison to their physician counterparts. This scenario raises alarm bells about the direction in which healthcare roles are evolving, questioning whether the drive for versatility and adaptability in midlevel practitioners is compromising the bedrock principles of patient safety and care quality.

PAs are often lauded for their adaptability, capable of navigating between specialties and settings with relative ease. Yet, stepping into surgical roles, traditionally the purview of extensively trained physicians, is both audacious and polarizing. This leap underscores the imperative for a rigorous vetting process and a formalized trajectory to ensure midlevels embarking on such paths are adequately equipped.

The “Curse of Knowledge” Cognitive Bias in Healthcare

Stephen DeVries’ case is a textbook example of the “Curse of Knowledge” cognitive bias in action—a situation where seasoned professionals, due to their extensive expertise and familiarity with their domain, find it challenging to view tasks and concepts through the lens of someone with less experience or training. When making decisions regarding the appropriate roles and scope of practice of midlevel practitioners like PAs, this bias can have profound implications.

The “Curse of Knowledge” cognitive bias can inadvertently contribute to a dangerous overestimation of midlevel practitioners’ abilities to grasp and execute medical tasks that demand a depth of knowledge and clinical acumen typically acquired through the prolonged and rigorous training undertaken by physicians. This overestimation is not a reflection of the competence or dedication of midlevel practitioners but rather a cognitive gap that can emerge when highly trained physicians project their own level of understanding and skill onto those with significantly different training backgrounds.

For instance, tasks that are routine for a seasoned surgeon demand not just technical skill but also a deep understanding of anatomy, physiology, potential complications, and the intricacies of patient management both during and after surgery. Physicians acquire this comprehensive expertise through years of medical school, residency, and often fellowship training, involving thousands of hours of direct patient care under close supervision. In contrast, midlevel practitioners, while playing an invaluable role within the healthcare team, typically undergo much shorter training programs with considerably fewer clinical hours that do not match the depth or breadth of physician training.

The ”Curse of Knowledge” cognitive bias underscores the need for careful consideration and evidence-based decision-making when determining the appropriate scope of practice for midlevel practitioners. It raises important questions about patient safety, the quality of care, and the educational requirements necessary for performing complex medical procedures. While the adaptability and versatility of PAs and other midlevel practitioners are among their greatest strengths, ensuring that these attributes do not lead to an overextension into areas where additional training and experience are crucial is paramount.

Moreover, this cognitive bias highlights the importance of fostering a healthcare environment where the roles and capabilities of each team member are not only recognized and respected but also clearly defined. It calls for ongoing dialogue, research, and policy development to ensure that all healthcare practitioners are utilized effectively and safely, according to their training, for the ultimate benefit of patient care. As healthcare evolves, striking the right balance between expanding roles and maintaining high standards of patient safety and care quality remains a critical challenge, one that demands a nuanced understanding of the knowledge and skills that different practitioners bring to the table.

A Call for Transparency and Educational Reform

 DeVries’ foray into independent surgical procedures signifies a notable deviation from conventional PA roles. While his journey might inspire, it also accentuates the critical need for standardization and oversight in midlevel practitioner training. The variability in midlevel educational programs, coupled with the lack of a uniform curriculum akin to medical school and residency, reflects a glaring negligence in healthcare education. This absence of standardization not only impedes the assurance of consistent competency levels among midlevel practitioners but also imperils patient safety and care quality.

 Organizations like Physicians for Patient Protection advocate for clear delineation of healthcare qualifications and stringent standardization in the training of healthcare providers. DeVries’ narrative, while showcasing the potential expansiveness of the PA role, simultaneously highlights the dangers associated with diluting practice scopes without adequate oversight and education. It accentuates the necessity for a healthcare environment where the roles and competencies of each practitioner are distinct, respected, and transparent, thus safeguarding the highest standards of patient care and safety.

The evolving dynamics of midlevel practitioner scope of practice, exemplified by Stephen DeVries’ remarkable undertakings, place a spotlight on the need to balance between potential advancement and the challenges of maintaining patient safety through standardized training and clear practice boundaries. As healthcare continues to adapt, maintaining clarity, transparency, and rigorous training for all practitioners is crucial, ensuring patient care and safety remain paramount in this new chapter of medical practice.