The AAFP Pushes Back


The AAFP joined the AMA and a host of other national physician organizations — as well as 43 state medical societies and associations — in asking the Department of Veterans Affairs to rethink its ploy to mandate that all advanced practice registered nurses (APRNs) within the VHA be designated as independent health care providers regardless of individual state regulations.  Here are some highlights:

  • The organizations argue that the nursing handbook, as drafted, “effectively eliminates physician-led, team-based care within the VHA system.”
  • Furthermore, every team — be it in the business sector or sports-related — needs good leaders. Physicians, with their high level of training and preparation, are best positioned to serve as the leaders of health care teams.
  • “APRNs are indispensable, but they can not take the place of a fully trained physician,” says the letter. Physicians provide complex diagnoses and develop treatment plans that address multiple organ systems. They are trained to both order and interpret tests related to a patient’s health condition.
  • “APRNs and physicians have skills, knowledge and abilities that are not equivalent, but instead are complementary,” says the letter. “Taking a team-based approach to care can address much of the primary care demand within the VHA,” it concludes.

Well, it’s about time.   This won’t go over well, by the way, with the supreme beings and the head honchos for the NPs.   Wait until you see the fallout and screaming and then the AAFP will capitulate, apologize and give in.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “The AAFP Pushes Back

  1. Lee PA-C
    December 5, 2013 at 4:32 pm

    As potential PA’s we went to school fully aware that we were not going to be independent practitioners when we graduated and if we didn’t accept that then we saved up and went to med school. Practicing medicine is about more than independence though, it is about knowing limits and we ALL have times when we need to call someone else for a little help. Almost every PA that I have worked with knew his limitations and knew when to call for help. It was ingrained in school that we had to know what we didn’t know.
    I do not see that so much with the NP’s that I have worked with however. Their rush to independence seems to have side stepped the lesson of knowing what you don’t know. They seem to want the privileges of being the “same” as doctors but without doing the studying and hard work to get there.
    I’m not saying that supervision must be direct but physicians do need to be in the picture and within calling distance. Doctors don’t need to be looking over our shoulders all of the time but checking should be done so that if there is a problem it is caught early and a remedy found. In one town where I worked the NP’s in a clinic were calling themselves nurse physicians and the patients were expected to call them “Dr”. I would hate to see that become a common practice.

    • Doug Farrago
      December 5, 2013 at 8:52 pm

      Amen. I don’t pretend to be a neurosurgeon and would expect to get more training and education to do so (actually, it is too late for me).

  2. Steven Gilles
    December 4, 2013 at 2:50 pm

    It comes as no surprise that physician led leadership groups such as the AMA and the AAFP would support limiting NP (and PA) practice scope.

    One of the roles of the AMA and AAFP is to insure physicians are in charge, set the rules and make the decisions about who gets paid what and who delivers care to whom and in what way. At the surface this approach is marketed by these groups as a means to insure proper patient care. Under the surface however, this approach is a turf issue where physician leadership fears losing ground and money to non physician primary care providers. Financially driven . . plain and simple under the guise of “Proper Patient Care”

    Can anyone here tell me why PA/NP providers working for the VA want to have expanded scope in primary care and less supervisory restrictions?

    Two reasons:
    1. We want to and are able to practice in rural areas where there are few physicians willing/able to take on such unpleasant jobs. These unnecessary limitations on scope of practice and oppressive supervisory rules do not allow for an NP or PA to practice in this setting effectively
    2. MD leadership group’s negative and derogatory approach to NP/PA providers has resulted in an increased desire by NP leaders to be independent of physician groups. So, in other words . . . MD leaders are causing the very problems they are trying to fight.

    Let me be clear. Most PAs do not want independent practice. Most NPs don’t even want independent practice frankly . . but the negative attitudes and slander spewed from the mouths of AMA and other physician leadership groups is basically forcing the hand of non physician leaders to promote their profession through clinical doctorates, practice law changes and less association/supervision from physician groups.

    Your AMA did it to the dentists, the osteopaths, naturopaths, the chiropractors and these groups went out and formed their own leadership, their own doctorates and their own training programs. To a lesser extent, the optometrists, the physical therapists, the pharmacists, the audiologists . . . all seeking their own clinical doctorates and their own independent scopes of practice.

    Of all of these, the PAs are the only ones who have said NO to a clinical doctorate and generally have said NO to independent practice and have stood firmly by the MD/PA team concept. Yet, sadly, the only response we get from this blog and from the AMA and AAFP is a negative one.

    So, agree with this article if you want to, and agree with the approach of the AAFP and the AMA regarding limiting NP/PA practice and keeping strict supervision in place . . but realize that it does limit access to patient care and it only bolsters the independent streak and fight for removal from physician oversight that it is trying to fight.

    Steven Gilles, PA-C

    • Doug Farrago
      December 4, 2013 at 2:55 pm

      Once again, you have no idea what you are talking about. At least you are consistent, though. You say the same old made up story over and over again. It used to make me angry. Now I just chuckle. You crazy LELT, you.

  3. Bridget Reidy
    December 2, 2013 at 10:40 pm

    I wonder how they came up with the idea that APRN’s are indispensable. Useful yes, but are they saying we can’t do what they do?

    • Doug Farrago
      December 3, 2013 at 6:23 am

      Good point.

  4. Ken
    November 29, 2013 at 11:59 am

    The AAFP: Keeping family practice the highest paid and most respected specialty out there!

  5. Pat
    November 29, 2013 at 9:27 am

    I recall a comment here earlier in the week regarding “the much more efficient VA system”…perhaps this is how they achieve their efficiencies?

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