Harsh Scope Creep and Hypocrisy of Bureaucracy: An Imminent Threat to Physician Sovereignty and Patient Safety

Dr. Adam Tabriz

The Hypocrisy Of Expanding the Scope of Responsibilities

Scope CreepPhoto byJeff Sheldon on Unsplash

Every profession and project has a set of assigned tasks that an individual must complete. Those are deliverables, project milestones, or reports that ought to be delivered efficiently, reasonably, and up to the specific standards set by the community.

Every scope of work pertains to assignments that come with a set of expectations and qualities.

In our modern realm, particularly in industries such as the healthcare system, there are often multiple stakeholders, amongst which miscommunication can deleteriously affect the quality of patient care. Establishing the proper scope of work helps alleviate such circumstances.

The assignment of and participating in a specific scope of work necessitates proof of education, training, and acquired skill set. Someone or a group must endorse those skills or the intellectual abilities to perform. Those are deliverables to be executed repeatedly within an assigned time and energy. Authorizing someone to those assignments is typically the expert in those already proficient in the complementary skillsets.

Today, in our bureaucratized human resources system, there is another level of authority over the scope of work; the licensing procedure. Bureaucrats legitimize the reason that supplemental enforcement of the work content is merely based on "public safety."

Nowadays, the licensing exercise serves as gatekeeping control over professions more often than not, even on those professions that do not necessarily present a direct danger to society.

Factors Influencing the Scope of Work in the Medical Profession?

Medical practice, like any other discipline, comes with particular skill sets and scope of work. Over the years, the medical profession has been formalized through various profiles and sub-profiles of fields such as surgery, Internal Medicine, Cardiovascular surgery, Endocrinology, and so forth.

In our contemporary world of schooling, medical education institutes and universities are where the experts of specific skills and scope of work offer training and certify new talents.

Naturally, the bureaucracy of the mainstream formal training curriculum restricts the certification of particular skill sets to individual profiles of the scope of work. Such policy metaphorically resembles confining the performance of appendectomy to the general surgeon. That scenario bans the fact that an internist who learns and is certified by another expert in appendectomy should also be able to perform the procedure. But often, that is different!

Today, regulatory boards dictate and thus change the scope of work for different healthcare disciplines with or without requiring particular certification. And they do so under the notion of "public best interest."

Undoubtedly, bureaucrats figure out when to decree policies for public safety or interest.

The hypocrisy of Scope Creep in Healthcare and the Role of Administration

Whenever, for any reason, bureaucrats expand the scope of work, deliverables, or classification of tasks for a reason.

The circumstance we are talking about is the concept of Scope Creep.

Scope Creep often than not, is about parameters by which administrators and dictators of the licensing system implement to bring economic rent in a society.

Generally speaking, Scope Creep is the result of one or more factors. Those include:

  1. Uncertainty of clear and precise scope of work in patient care
  2. Lack of consensus among the stakeholders and patients
  3. Powerless leadership, or lack of clinician control over the patient care
  4. Differing stakeholder opinions
  5. Not involving the patients throughout their care
  6. lack of proactive communication
  7. lack of prioritizing
  8. Lack of consensus on change
  9. lack of estimation

Although what is mentioned above is a consensus on the causes of scope creep, we can witness that day in and day out. That is if we consider every patient care scenario as an independent project or assignment. Every day we can realize letdowns on one or more of the mentioned reasons for scope creep.

Scope Creep in healthcare is a prominent yet poorly recognized phenomenon. It is an obstacle in the healthcare system that has propelled healthcare bureaucrats to meddle in the professional lives of physicians and clinicians. They dictate how they should practice and what to do (or not to do) to save healthcare costs.

Physician BurnoutPhoto byElisa Ventur on Unsplash

The introduction of a value-based reimbursement model, a mission to engage patients in their care, has contributed to the scope creep across the healthcare system. Those are policies like incorporating the management of social determinants of health into physicians' list of tasks, expanding the duties of nurse practitioners to work without supervision in specific settings, and incorporating data entry tasks into physician workload.

Unfortunately, the stance of regulatory agencies, at least in the United States, needs to be more specific.

For instance, according to a report published by American Medical Association (AMA), the agency is leading a coalition of various national, state, and medical societies to block several pieces of legislation.

Those legislations mediate scope creep to medical services and clinical procedures that nonphysician healthcare professionals are traditionally allowed to perform. The same association is also the organization that, in 1986, called for minor registration in medical schools to curb the supposed physician "surplus."

Reportedly, AMA in 1997, the agency lobbied the government to reimburse hospitals not to train physicians!

In addition to hypocrisy-riddled AMA actions, the association supported creeping bureaucratic physician tasks and expanding primary care responsibilities for general practice physicians under physician-led care.

Then again, expanding the scope of work is reasonable as long as the individual has the necessary training and is reimbursed fairly for that scope creep.

Today's administrations prohibit professional sovereignty. Such a control causes injury rather than social protection, even when it comes to scope creep.


Lobbyists of scope creep are from diverse backgrounds. Some are for, and others stand against clinical practice scope creep. However, none consider clinicians' choice, knowledge, and competency in that particular scope of work.

What differentiates scope creep from skillset expansion is the appropriate and legitimate competency. Scope creep depicts the bureaucratic approach to patient care. In contrast, the individuals' training, competence, and free will must determine any area of work boundaries.

Every clinician must be able to set their particular scope of work, in any shape or form, without prejudice as long as they prove their competence.

That is whether via partaking in mainstream training or unconventional means of skill learning like mentorship and preceptorship.


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Illumination Publication initially publicized this article on Medium!

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