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The diversity of doctoring

The diversity of doctoring

What does it mean to be a physician? Providing patient care has long been considered the most noble, intellectual and altruistic aspect of being a doctor. While a nostalgic notion, such a traditional mindset can be divisive. It oversimplifies the complexity of medical practice and the variety of expertise needed to promote and support health.

Also, adversarial notions can result, comparing: the abilities of doctors versus other healthcare professionals and disciplines; interventional versus cognitive clinical specialties; and doctors in the traditional sense versus those trained as doctors who pursue alternative careers.

Modern health care needs to cross traditional boundaries beyond care teams and hospital walls to innovate and evolve healthcare systems. I believe that the medical community in my home country could learn from the Dutch in this respect.

In the Netherlands, upon obtaining a medical degree, a basisarts registers in the Dutch system -- the Beroepen in de Individuele Gezondheidszorg, or BIG-register -- and goes on to train towards practicing clinical medicine (as arts in opleiding tot specialist, or aios) or find another position as arts niet in opleiding tot specialist, or anios. Simply having a medical degree, without further specialty training, offers numerous formally recognized career opportunities in the Netherlands.

In the U.S., the equivalent of anios are more likely to be seen as either those who failed to find a clinical specialty training position (known as The Match), or those who deliberately abandoned the noble service of doctoring. I recently encountered a label for the latter group of physicians in a U.S. context: physicians in name only. While the label may not be commonly used, its embodiment is. PINOs are no longer considered “real” doctors because they gave up the defining social service that is seen as being a doctor. In reality, these doctors aspire to use their specialized knowledge for leadership, innovation, advocacy, and other creative, hybrid applications for society’s benefit.

Social, political and technological systems are constantly changing and healthcare systems are striving to adapt. It’s time for the medical profession globally to adapt too, and acknowledge that physicians can still be valuable and offer social good by applying their skills beyond traditional one-on-one doctoring.

Tiffany Leung, assistant professor at the Faculty of Health, Medicine & Life Sciences

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