I’m now an unleashed doctor! Since I retired from a busy family medicine practice, I discovered the benefits of having an MD degree and no licence to practice.
Universities confer the academic degree MD (medical doctor) on students who complete a particular set of studies. The degree is worth less than it appears, because the academic designation MD doesn’t come with a licence to practise medicine.
In Canada, colleges of physicians and surgeons, or their equivalent, are responsible for licensing. Holders of medical licences can legally provide a more or less complete set of medical advice and services. However, they must bill only the government insurer, at the government-approved rate, for medically necessary services.
Licensed doctors do some things forbidden to anyone without a licence. They can order laboratory and imaging investigations, they can order prescription drugs and some perform operations.
The unlicensed doctor can charge whatever the doctor and person asking for medical information agrees the service is worth.
As far as the colleges and government are concerned, the unlicensed doctor providing information is in the same category as a parent or grandparent, pharmacologist, biochemist or anyone without medical training.
There are benefits. Unlicensed doctors can assure people that discussions remain confidential and private. Neither the government nor the college of physicians and surgeons can ask to see the person’s record.
Regulators expect credentialed physicians to keep detailed notes and descriptions on even minor problems, like a simple upper respiratory infection, otherwise known as a cold. Unlicensed people don’t have this recording imposition on their time. Instead, they can use the time to do other more pleasant or productive work, such as answering questions and keeping up with medical research.
Parents, grandparents and unlicensed medical doctors can all search the literature to find answers to important medical questions. However, unlike relatives and licensed clinicians, the unlicensed doctor is relieved of the responsibility of making value judgments on behalf of patients; instead, they can help people to understand and oversee their own care. That’s the way it should be!
The unlicensed doctor might provide information that patients rarely get from licensed doctors. Confirming or disproving a diagnosis of fatigue is challenging for all of us. There are over 2,000 possible causes of fatigue, and the medical literature describes what’s necessary to confirm or disprove any particular cause. Knowing this helps people understand that, occasionally, finding causes and treatments requires patience and co-operation.
The unlicensed doctor can also provide research information about the possible benefits and harms of treatment. For example, the research shows how many people who take Aspirin to avoid a stroke will benefit and how many will suffer from a major bleeding event requiring a blood transfusion.
Health care is not mystical. Anyone who’s interested and knows what questions to ask can find pertinent research related to diagnosis and treatment.
Being unlicensed makes it clear to the people asking for advice that they have the responsibility to decide what to do based on their own understanding of the information.
Moreover, if people feel they need further investigation or drug treatment, they can always visit a licensed doctor and ask her to order appropriate investigations or drugs. This might be an inconvenience; however, a second opinion typically reduces the chances of error.
David Zitner is senior health policy fellow at the Atlantic Institute for Market Studies, and a retired family physician.