We write this not intending offense, but knowing it will offend some, even some for whom we have great love and respect. We write this not to divide, but to raise awareness. We write this because our continued silence may have implications for the safety of patients and we’ve pledged first to do no harm. Right now the acting Surgeon General (“The Nation’s Doctor”) holds not a doctorate of medicine, but a doctorate in philosophy. And our physician colleagues who have dared to question these changes are being shamed, mocked, and have become the subject of name calling; and that’s not counting the ones too afraid for their jobs to speak their opinions.

Don’t get us wrong, many of us work with and love many NPs, PAs, CRNAs, etc. and feel they play a vital role in healthcare delivery in this country. There are systems that function as great models in regards to how all these levels of providers can work together for the betterment of patients. But the trainings are not equal and the general population has not been made aware of the distinctions and we have each seen unnecessary complications or negative outcomes resulting from practice beyond the scope of training.

Somewhere along the way, it’s become "elitist" and "arrogant" for physicians to assert themselves as physicians. We’ve been shamed for using our titles, told other practitioners are “just as equal” and that we’re all “practitioners”. To become practicing MDs/DOs – generalists in our fields (including the much maligned and underappreciated primary care physicians) – we must have 4 years of undergraduate training, 4 years of medical school (one ENTIRE year of which is pathophysiology, or how disease processes occur and including 2 years of clinical training). Yes, we have >2,000 clinical hours before we can even write an order for an x-ray without direct supervision. Then, and only then, do we enter a minimum 3 years of residency where we attain another 11,000+ hours of supervised clinical experience before we are considered eligible to sit our board certification exams and practice independently. It doesn’t matter our background or experience (yes, even having practiced as an OB/GYN previously, one must perform all the clinical hours of an internal medicine resident to become an internist) because we’re training for what we’re going to be, not what we were. There is not a practitioner degree program out there that matches an MD/DO’s pathophysiology or clinical training (in contrast, NP programs require 500-700 hours of clinical training in total); there is not another program that awards their doctorate based upon clinical experience rather than a thesis project.

So when we have someone with a doctorate of philosophy acting as our nation’s Surgeon General, yes, it raises eyebrows and starts the alarm bells ringing. No, there is not a mandate that the Surgeon General be an MD/DO, but the Surgeon General is the head of the Commissioned Corps, a healthcare system whose mission is the advancement of public health and who can be deployed immediately in public healthcare emergencies, i.e. doctors there when things are at their worst. It’s hard to fathom having someone with less disease process knowledge and clinical experience than those they're supervising direct the workings of this group and it’s because of this we ask you, Mr. President and Mr. Assistant Secretary for Health, to appoint an MD/DO to the position of Surgeon General.

Thank you.