I have watched the scope-of-practice debate for decades, from call rooms and crowded wards, from intensive care units and emergency departments, and from the deafening quiet that follows a code well run yet not won.

Early in my career, I argued the way many physicians do, with outcome data and workforce projections. Over time, I came to see that those arguments skirt the deeper question: When clinical authority expands, does accountability …

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Physicians are often described as leaders of the health care team. The language shifts, quarterback, captain, final decision-maker, but the implication is constant: someone is clearly in charge. At the bedside, the reality feels more complicated.

In every functioning system, there is a final point of responsibility, the person who answers when outcomes are poor. In medicine, that person remains the physician. We sign the charts. We carry the malpractice risk. …

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