All health care providers are not created equally

I’m a physician. I’m not a “health care provider.” I hate that term.

The insurance companies call me a “provider.” In a sense, it’s true. I provide health care services. However, over the past few years I’ve noticed that the lines between different types of “providers” are getting more and more blurred. Sometimes they’re blurred to the point that patients don’t even know what kind of “provider” they are seeing.

I often have patients tell me about their previous doctors, only to review old records and find that their “doctor” was a nurse practitioner or a PA. I’ll be reviewing lab tests that look kind of unusual, only to find that they were ordered by a naturopath. And so on. I’m not saying that there’s not a place for everyone in health care. I’m not saying that physicians are at the top of the hierarchy (trust me, most days I feel like I’m in the basement). I’m just saying that patients deserve to know who is providing their health care and what their training is.

Here’s an example, something that I’ve been reading about as a result of my interest in running.

On February 5, 2011, the annual Kaiser Permanente Half Marathon took place. As is typical of large races, Kaiser was the main sponsor but outsourced the race management to a company called RhodyCo Productions. It was an unusually hot day for February. About 2 hours into the race, a 36 year old man named Peter Hass neared the finish line. As he approached it, he collapsed. Apparently, it took more than 20 minutes for an ambulence to arrive. Other racers performed CPR. Sadly, Mr. Hass died, apparently of a cardiac event.

The City of San Francisco has now released a report regarding the events of the day. You can link to the full document and read it. There were obvious problems in communication and there did not appear to be enough ambulances present. However, this stood out to me:

There were several items listed in the EMS Plan for this event that were not adhered to by the permit holder for the event, RhodyCo Productions. For example, the number of EMTs at the starting and finish lines was insufficient, pursuant to EMSA Policy 7010. Additionally, chiropractic students were used as medical staff rather than EMTs or emergency medical personnel. The EMS Plan also stated that one MD would be stationed at the Medical Tent or at the event, which did not occur. Rather, a chiropractor from PCCW was provided.

Whoa. Double take. Triple take. There were no MDs present. The production company was using students from a chiropractic college as “medical personnel.”

What? This can’t be true, can it? So, using the powers of Google, I investigated futher. For those of you who don’t want to click, it’s the RhodyCo Productions Emergency Procedures for the 2011 San Francisco/Kaiser Permanent Half Marathon. It states:

There will be Medical Personnel onsite at the START line till the last runner/walker passes. There will be medical personnel at the Finish Line for both the 5K and Half Marathon till last walker/runner crosses the finish line. There will be a minimum of 3 Medical Personnel mobile on the course during the race.

Sounds good, right? Sounds like “medical personnel” will be ready and available. Until you read a bit further, that is.

Medical Personnel: Palmer College of Chiropractic West Sports Council will provide event trained medical teams for the event (students are all CPR certified and have taken emergency response class). The head clinician event day, Dr. Hal Rosenberg, (phone number redacted) will be onsite at the post-race Medical Tent.

Yup. It’s true. They had “health care providers” present. Except they were chiropractic students. Even if they were real, live, actual chiropractors, they still wouldn’t have been qualified to provide emergency medical services at a half marathon, unless they were also EMTs or paramedics. But wait, what about Dr. Hal Rosenberg? He’s a doctor, right? At least he would be overseeing the medical response team. Right? Except, not. He’s a chiropractor, too.

It’s true that running a half marathon is an inherently dangerous activity. A distance runner is pushing his or her body to its limits. Even elite athletes die during endurance events. That’s why all these events make you sign a liability waiver prior to participating. However, this is what the half marathon website says about available medical support (from the 2012 race page, I’m not sure what the 2011 page said, but this is fairly typical):

Medical Support

Medical Support will be overseen by a Medical Director experienced in event medical response.

There will be a Medical Tent staffed with trained emergency personnel at the start line, at the finish line and in the expo area of the event.

Ambulances will be located at the start line, on the course, at the finish line and in the expo area.

There will be mobile Medical Teams at each of the 5 water stations and roaming the course throughout the race.

Medical personnel will be clearly visible, wearing a medical response uniform.

Race monitors on the course will be in constant communication with the Event’s Medical Director. If there is a medical need on the course, please let one of the course monitors know as soon as possible and they will call for medical assistance.

Reading that, wouldn’t a reasonable person assume that there will be physicians present?

Would having physicians present at this race have changed the outcome for Peter Hass? I have no idea. There’s no way to know. However, don’t you think racers deserved to know that the “health care providers” at their endurance sporting event weren’t physicians, but chiropractors and chiropractic students? All health care providers are not created equally.

Marni Nicholas is an internal medicine physician who blogs at Patients, Patience, and Paces.