Medical Turf Wars

Turf wars are another part of the ugly underbelly of medical practice and will continue to be in the foreseeable future, as long as disparate medical interests lay claim to dwindling resources and profits.

Many years ago, when otolaryngologists (ear, nose, and throat surgeons) were fighting to be recognized as experts in facial plastic surgery, I was involved in suing the Colorado State Board of Medical Examiners to defend my right to be listing as a “facial plastic surgeon” in the Yellow Pages. (For those of you who don't remember, the Yellow Pages is that big, thick, yellow book that most people just recycle or use as a door stop these days.)

With the support of several specialty societies funded by a political action war chest, we won the case. Among other things, the case established a precedent and the set the groundwork for the eventual growth and development of the American Board of Facial Plastic and Reconstructive Surgery. Facial plastic and reconstructive surgery is now a recognized, significant part of the practice of otolaryngology. Head and neck surgery and testing concepts in facial plastic surgery represent a significant part of the board examination process.

As long as there is ego, fear, and greed, there will be medical turf wars. The latest are MDs battling with non-MD providers. Interventionalists are trying to carve out the turf previously reserved for other specialists. Dentists and oral-maxillofacial surgeons want to claim that part of your craniofacial real estate from MDs too. I was a bystander to the birth of the emergency medicine specialty.

In the meantime, patients are wondering who is representing their interests and are increasingly confused by the branding and marketing messages flooding the internet and online sites.

Turf wars are another part of the ugly underbelly of medical practice and will continue to be in the foreseeable future, as long as disparate medical interests lay claim to dwindling resources and profits. Some would argue that the turf wars are simply the free market at work. Others, in the name of protecting patients and quality of care, claim they are applying higher standards to protect the public interest, or, by creating innovative care models delivered by non-MD provider substitutes, that they are simply serving a market need without sacrificing quality of care. Others see it as a cartel just trying to protect their pocketbooks and those of their members.

The resolution of these conflicts will depend on many social, political, regulatory, legal, and economic factors. However they play out, they are a part and parcel of medical practice. Participants should expect to engage instead of just wishing they would go away.