To the Editor.—A recent article (Archives 115:310-314, 1980) discussed the use of nonmedical "surgical residents" or physician's assistants (PAs). What is advocated, in effect, is the production of partially trained practitioners who will perform many of the functions normally considered the "practice of medicine." These include taking histories, performing physical examinations, suturing lacerations, placing central venous catheters, performing tracheostomies, and writing preoperative and postoperative orders. Despite the disclaimers of the authors, I suspect that such programs are in fact producing incompletely trained physicians who, with more or less "supervision," are actually practicing medicine.
This is a transparent evasion of licensing laws. Such a system obscures or obliterates the boundaries of the medical profession, which has taken many years to establish its present high levels of general competence. To bypass this long and arduous course of training for the economic advantage of surgeons in medical centers is unjustified and unwise.