Baylor University Takes Down Misleading NP Page

Dr. Duprey explained how their conclusions were flawed here. And now the page is gone. It was supposed to here but all we get now is:

Why do you think they took it down? We hope because they also realized it was flawed and someone complained (like us).

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  3 comments for “Baylor University Takes Down Misleading NP Page

  1. Mamadoc
    March 11, 2020 at 10:31 pm

    When I was in practice I dealt with this nonsense by not using that specialist again.

  2. Bridget Reidy
    March 6, 2020 at 2:39 pm

    A good use of specialist extenders would be fulfilling the billing requirements of a new visit, but there’s no reason the specialist can’t then do what they were referred for. What a joke. And what an insult. Maybe if referred by a noctor that visit without the doctor could be considered medically necessary, otherwise it’s not and it’s billing fraud.

  3. Frank Savoretti, JD, MD
    March 6, 2020 at 8:39 am

    Congratulations on at least one small Victory! I have copied several a couple of your essays on NP’s-PA’s into my electronic medical record and send them to specialists’ offices as my reply to their requests for referral authorizations for my patients to see their Physician Extenders: DENIED! My patients get the Doctor or I’ll handle it myself. You might be interested in reading the following commentary by Joseph Friedman, MD on the topic published in the Rhode Island Medical Journal last September, 2019 which I also send to offending specialists. Copied and pasted below for your ease of reading. Dr Friedman is the local movement disorder specialist in Neurology who is well known in the whole country and world for his expertise in Neurology and Parkinson’s Disease.

    “Rhode Island Medical Journal, September 2019

    http://www.rimed.org/rimedicaljournal-2019-09.asp

    Physician overextenders

    JOSEPH H. FRIEDMAN, MD

    I recently learned from
    a scheduling secretary
    that my new patients frequently
    ask, Am I going
    to see Dr. Friedman?
    She told me that patients
    often find themselves
    referred to specialists by
    their primary care physician
    (PCP), only to see
    physician extenders and
    not the physician. Many
    patients also tell me they have never even
    seen their Primary Care Physician, only the physician
    assistant (PA) or the registered nurse
    practitioner (RNP).
    I am a strong believer in physician
    extenders, the cadre of RNPs and PAs
    who have been increasing the amount
    and quality of care in the U.S. I have
    had the pleasure to work with some on
    a day-to-day basis and can attest to the
    benefits they provide. However, there
    is a limit to their capabilities and their
    increasing use as subspecialists without
    oversight has unnerved me.
    A recent patient, transferring care
    from another state, thanked me after her
    examination. Thats the most complete
    exam Ive had since I saw the PA in my
    previous neurologists office. The doctor
    never examined me. What should one
    think of a neurologist who doesnt examine
    a patient? The neurological exam is
    the heart of the discipline.
    I have referred patients with gait abnormalities
    to orthopedists to determine if
    a particular joint problem
    or set of joint problems
    might explain a peculiar
    gait. I consider myself a
    clinical gait specialist. I
    have given medical grand
    rounds at other universities
    on assessing gait disorders.
    I give a talk every
    year to geriatric internal
    medicine fellows, and
    occasional gait lectures
    to other groups. Gait disorders may be
    complex and I am often stumped, and
    therefore request opinions of others,
    who I believe will have more knowledge
    or experience in some aspect of the
    problem, since walking problems are
    often due to more than one contributing
    problem, like a brain disease plus bursitis.
    Most physicians, including neurologists
    and orthopedists, are uneasy
    assessing gait disorders. So, imagine
    my surprise to see my referral addressed
    by a PA. Ive seen patients referred by
    a neurologist to a neurosurgeon, who
    saw only the neurosurgeons PA who
    then sent the patients to me. The first
    neurologist would have sent the patient
    to me directly if he wanted my opinion.
    He wanted the neurosurgeons, which
    he never got.
    I sent a patient to a spine specialist
    because I wanted to be sure that her
    scoliosis was due only to Parkinsons
    disease and not to an intrinsic spine
    problem. The patient told me that the
    PA told her that she had degenerative
    joint disease and scoliosis due to
    Parkinsons disease, which is what I
    had thought, but I wasnt sure if this
    assessment was correct, which is why I
    sent to patient to the orthopedist in the
    first place, and without an orthopedists
    opinion, still dont know if it is correct.
    I wouldnt have thought twice about it
    if I knew this was the spine specialists
    opinion. I sent a letter to the spine orthopedist
    to ask if I needed in the future to
    specify that he needed to see the patient!
    Not only that, but the same day I asked
    a patient why he limped after his hip
    replacement. He didnt know. Didnt
    the orthopedist who operated on you say
    something? I never saw the orthopedist.
    Never? He came to the emergency
    department before the operation,
    but I never saw him again. In seven
    months! Luckily, this has not been the
    experience of most of my patients who
    have had hip or knee replacements, but
    the fact that this was deemed acceptable
    behavior was a surprise to me.
    I understand the need for physician
    extenders and have worked with them.
    When I worked with RNPs, I used them
    only to see patients who I had first evaluated,
    and I considered relatively stable.
    If the patient was found to have not been
    stable, the RNP would get me so that
    I could review the case, at that time. I
    cant imagine why a fellow physician
    would refer a patient for a non-physician
    evaluation. Ive had patients tell me
    they were referred by a rheumatologist
    to an orthopedist and saw the health
    extender. Imagine, a doctor, possibly a
    specialist in a related discipline, sends a
    patient to another specialist in a closely
    related discipline and sees someone,
    perhaps a PA with 2 years of training,
    for an opinion. Aside from betraying a
    profound lack of respect for the referring
    physician, it displays one of the many
    weaknesses in our health care system.
    We train too few doctors, burden them
    with time intensive requirements that
    are not reimbursed and then use less
    well-trained health professionals to help
    compensate. This allows more patients
    to be seen in a timely manner, but for
    consultations, it may actually delay
    being seen, since the patient may have
    to wait again, several weeks, or months,
    to see the doctor.
    It upsets me to think that my surgical
    colleagues think more of their PAs than
    they do of their medical colleagues or
    me. I am generally not keen to refer my
    patients to newly graduated surgeons,
    since they lack much experience. Why
    would a PA or an RNP be an appropriate
    substitute?
    I now have my patients check to make
    sure they will see the doctor, and call
    me for an alternative referral if not. I
    may lose doctors Ive dealt with over the
    years but why tolerate a drop in quality?
    I am further asking you, the reader,
    to do the same. Physician extenders
    have a major role to play in health care.
    They can provide special services, like
    follow-ups after an operation, learning
    to identify danger signs so that they can
    call the doctor on call, to change dressings,
    reassure the patient and further
    supplement the routine care that used
    to be provided by registered nurses. They
    can likely sew up some lacerations,
    apply casts, assist in the interventional
    radiology suite, insert canulae and catheters,
    and follow patients in the office
    who have well-defined problems. If they
    can substitute for the doctor completely,
    why not get rid of the doctor and save a
    lot of money?

    Author
    Joseph H. Friedman, MD, is Editor-in-chief
    Emeritus of the Rhode Island Medical Journal,
    Professor and the Chief of the Division
    of Movement Disorders, Department
    of Neurology at the Alpert Medical School
    of Brown University, chief of Butler Hospitals
    Movement Disorders Program and first
    recipient of the Stanley Aronson Chair in
    Neurodegenerative Disorders.

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