1/The message from @AmerMedicalAssn to “Stop Scope Creep” flags a signal in opposition to the lessons I gained from 24 years of care for persons experiencing homelessness.
https://twitter.com/DrScottHadland/status/1379781138944770048
2/I can imagine some specific tensions that do arise for generalist MDs like me if payers supplant us fully in favor of other clinicians - but a broadcast hashtag #StopScopeCreep runs smack into many other competing and serious problems
3/First: in my world of caring for persons experiencing homelessness, I have been teamed up with Nurse Practitioners and Physician Assistants and RNs whose training and life experience are absolutely crucial, and compensate for my limitations
4/For patients with high levels of adversity and trauma in life, often it is the physicians who have re-enacted aspects of trauma in health care: sometimes it requires a non-physician to engage, often with a nursing disciplinary background. That is our team by the way : 
5/Pharmacists don’t “replace physicians” but there is a significant amount of guidance they do provide and medications that they do help manage in large health systems.
6/#scopecreep sometimes is necessary. After interviewing homeless care teams, I heard this: docs who work with patients who are homeless sometimes must take on nursing & social work labor, or the right and necessary things don’t move forward for the person in front of us!
7/I admire and appreciate @AmerMedicalAssn for much crucial work on multiple issues right now, including pain & opioids. However I think the matter of “Scope” needs some re-deliberation. Ask: What is the goal here and what do patients need and whose help do we need?
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