“What Kind of F**kery is This?”

Medicine is going to hell in a handbasket. Bats**t crazy.

Optometrists…they wish to perform surgery on one of the most delicate areas of the human body. The eye. No matter that they don’t possess the training, just take an expedited course and walla!! Your eyeball is in their incapable hands. At a discounted price no less. Don’t you feel all warm and fuzzy inside? Too bad you can’t see anymore. Because no one asked who would correct the mistakes that were inevitable. You see, that isn’t part of their training. To fix the f***ups. Oh well. Better send the patient to the opthalmologist to fix it.

Psychologists…they want prescribing rights. To treat psychiatric patients. Pay no mind to the fact they know nothing of psychopharmacology in depth, that is just an annoying hoop they don’t want to jump through. Why bother when they can just go to the legislators and convince them it’s a good idea to let them write these prescriptions anyway after taking a certification course? Hell, they specialize in talk therapy. Meh, legislators are a piece of cake; talk them to death and contribute to their campaigns and they will agree to anything. Who cares that psychiatric drugs are some of the most dangerous prescription drugs on the market and can be disastrous for kids and the elderly if one doesn’t know how to administer them? Well, it’s not their kid and the elderly have to die sometime. And everyone else in between? Hit and miss. You see, during the blathering in the state house and senate, no one asked who would manage the mistakes. It didn’t matter. If there’s a f***up, just send them to the psychiatrist to fix it. Or to the ER physician.

Pharmacists….the experts hands down in pharmaceuticals. Sure, they know enough to prescribe. Except if the patient has co-morbidities(illnesses) or other medical issues that are contradictory to what they want to prescribe. Why bother to talk to the primary doctor? His/her input is neither wanted nor needed. By golly, the pharmacist knows meds. Ah well, no need to worry. Primary care is easy as pie and should the patient crash he/she won’t be coming to the pharmacy anyway. Unfortunately, the pharmacist doesn’t know the patient like the physician does nor does he/she know primary care. You see, no one asked what would happen when the pharmacist f***ed up. No need to understand the error, let the primary care doc manage the damage or just send the patient to the ER.

Chiropractors/Naturopaths/Other alternatives….not going to elaborate, you get the gist. They are doctors…just not medical doctors. They’re yakking to the legislators also. Seeking to practice the art of medicine by legislation, not education. It’s sick. Pun intended.

Now enter the non-physician practitioners(NPPs). Nurse practitioners and physician assistants, with the assistance of oblivious physicians, nescient legislators and now a very accommodating pandemic, have decided, arbitrarily, that their non- or limited medical training is an acceptable alternative to the actual practice of medicine. Years of practice should count they say, so much so that they no longer require supervision by professionals actually trained and licensed in medicine. This is supposedly proven by studies on outcomes(with questionable methodology), quoted as being factual and valid, hoping that if they repeat it enough it will come to be. And it has. Fiction has become fact. They have taken their cackling over to the legislators, who, like good husbands who know better, just say “Yes Dear” and give them what they want, which is Full Practice Authority (FPA) and Optimal Team Practice (OTP), aka: practicing medicine without a medical license. “But hey!”, you ask, “Isn’t that against the law?” Yes. Yes it is. Legislators, many of whom are attorneys, pass a law that allows non-physician practitioners to break the law–legally. Oxymoronic morons. But at least it stops the nagging. As far as the patients who suffer at the hands of a person who lacks a solid medical foundation and appropriate training? Acceptable damages. As long as none of the offenders or legislators are related to the patient, who gives a damn? Patients are expendable. When one dies(or is injured), another will replace him/her. You see, no one asked what would happen when the NPP’s f***ed up. So for the patients that are harmed? The mistakes for which the NPPs were never prepared? Just send them to the physician to be made whole again. Send them to the real doc. The medical doc. Hell, we are good for something after all. And that is to correct everyone else’s mistakes. While the predatory lawyers circle like vultures waiting for the kill while we are forced to extend our liability to assist those who engage in professional appropriation (https://authenticmedicine.com/2019/12/professional-appropriation-a-new-term/).

To all the legislators, corporate medical groups, medical facilities and physicians who are supporting this agenda of replacing physicians with anyone and everyone because you have determined that their education is equivalent to ours for profit-driven purposes, you will be a patient one day. You may end up in a situation in which you have no choice and no voice, much like the public is experiencing now. And your position and/or title will mean nothing. You will ask for a physician and there won’t be one.



1.  Quote from the song “Me and Mr. Jones” by Amy Winehouse

***DISCLAIMER: My commentary refers only to those for whom the shoe fits.***

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Natalie Newman MD

Dr. Natalie Newman is a residency-trained, board-certified emergency physician who has been practicing for over 20 years. She graduated from California State University in Sacramento, California with a degree in Biological Sciences. She then attended medical school at Case Western Reserve University in Cleveland, Ohio on an Army scholarship. As a graduating senior, Dr. Newman was presented with the Marjorie M. and Henry F. Saunders award for her compassionate care of patients within the family structure. After her graduation, she was accepted into the Emergency Medicine Residency at North Shore University Hospital in Manhasset, New York. Upon her graduation, Dr. Newman entered active duty service with the U.S. Army. Her first assignment was at Womack Army Medical Center in Fort Bragg, North Carolina. During her stint in the Army, Dr. Newman was deployed to Bosnia-Herzegovina(formerly Yugoslavia) where she was Chief of the Emergency Department at Eagle Base in Tuzla, Bosnia. She had the honor of serving under the command of Colonel Rhonda Cornum(now a retired brigadier general), a urologist, pilot and former prisoner-of-war during the Persian Gulf War. While in Bosnia, and as the only American female physician in the Balkans at that time, Dr. Newman was assigned as the official physician for Queen Noor of Jordan during a humanitarian visit to a local hospital in Bosnia. After her return home to the U.S., she was promoted to Major and completed the rest of her Army service at Fort Bragg. Dr. Newman subsequently returned to her home state of California. She has worked in rural facilities, community hospitals and trauma centers. She has also served as a ship physician for a major cruise line and also provided physician services at the Coachella/Stagecoach Festival in Indio, California for three years. Dr. Newman participates in public speaking engagements discussing the value of education, of which she is passionate. She continues to practice clinically as a traveling physician.

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46 Responses

  1. Diana says:

    I am an FP, practicing for over 20 years. I have worked with PA’s before in their roles and have not had issues. Great relationships. But I would never think of them on the level of a physician. With laws being challenged in so many states, I have now had to deal with more and more unsupervised PAs and CRNAs’s results. For the need to act as a physician, I have patients that end up with wrong diagnoses, ICU admits, reactions to meds…. and for what? For the ego to practice medicine independently, unqualified?

    Now much like it goes on the political field, you have this nurse (CRNA) threatening a female physician if he does not get what he wants. Threatens to publicly attack and shame (although it is the truth). How are threats in this day and age allowed to be confused for rights? So the only way you. Prove your worth is by threatening others — well that makes me confident in your skill! Not!!!

    Thank you for writing this article. I completely relate and agree. I think that bullying and threats should not be allowed. This is a place to discuss ideas.

  2. A medical resident. says:

    Thank you Dr Newman

  3. Physician led anesthesia care team says:

    You are spot on. Thank you for your wisdom and bravery. I dont know why CRNAs are ashamed of the path they chose and try to inflate their training. But mostly I don’t know why they try to threaten people who speak only truth and promote teamwork. As a physician I never want to practice above my area of training. I do jot pretend to be trained As a cardiac anesthesiologist when I didnt take the additional time to attend that training. I dont feel threatened when a cardiac anesthesiologist says they have more training than I do bc its the truth. Keep telling the truth.

  4. Jolie Bailey, M.D. says:

    Great article! Sigh, male CRNA attacking female physician. I wish I hadn’t experienced it so many times over. Anesthesiologist here. I’ve had a male CRNA actually grab my chin in his hand while trying to talk down to me. I’ve had one body block me when I decided it was time for me to take over the placement of the spinal. I’ve had one tell me his “BRUTane” was all that was needed for the difficult airway when I asked to take the first look. And on and on and on. I’m sorry they’re targeting you, Dr. Newman.

  5. Alex says:

    This is a great fear that one day we will be led to being treated by the same people who lack the experience and capability this has turned into everyone can “just” prescribe a BP medication to everyone can “just” take care of our sickest elderly patients in the hospital with a certificate course and no real training and a superficial education ! Frightening times

  6. Raja says:

    Keep up the good work

  7. Anna Z says:

    wonderful article and spot on !!!

  8. Su says:

    ?????? You hit the nail on the head!!

  9. BAFAD, MD says:

    Funny how the male nurse anesthetist starts out saying that “respectfully you have right to your own opinion” then continues to be purposefully disrespectful in an effort to discredit a beautifully written and honest reality of the downfall of healthcare in America. It’s not surprising to see this type of behavior or attitude as it is what’s being incorporated into their training in an effort to undermine physician led care. It is an abuse that is experienced daily by female physicians of all specialities by male and sometimes female mid level providers in an effort to try to exert some false sense of superiority over the real expert in the room.
    First of all, no physician requires or depends on a mid level provider, we were taught and trained in all aspects and specialities of medicine in medical school and then complete additional dedicated training in our medical speciality to become the official medical experts of our chosen profession.
    Hospitals or CEOs who are profit driven might “depend” on mid-levels but only to the security of their overall bottom line.

    Studies do show that patients given the choice prefer physician care.

    Second, your statement “ You can’t wish the Genie back in the bottle no matter how hard you try, and creating a campaign of fear only goes so far before it undermines public trust”, speaks volumes, but not in the way you intended. You are right, the so called genie is out of the bottle and the way mid level providers attempt to undermine public trust with deceptive titles is alarming. When a patient is unable to determine that the person they are seeing isn’t a physician because the nurse with a clinical practice doctorate refers to themselves as ‘Doctor’ in the office then there is a problem. If you are proud of your nursing training and feel it is equal or superior to a medical education then why deceive your patient by calling yourself doctor? Why not be truthful with the patient? This must be something else that is taught in the mid level curriculum, “how to deceive the patient”.

    Also, the organizations who spend the most time, money, and effort on politically and professionally undermining healthcare and physician led care are the various nurse practitioner organizations. With slogans like “we are the answer” and “remove restrictive physician barriers” how can you argue that you are in fact the ones spending the most time and money plotting? You even have courses in your training programs on how to advocate in the political arena.

    Instead of always trying to call names and throw punches at physicians, why not step up to the plate and be a professional for once and make an intelligent response to something you disagree with. Endless banter about civil war anesthesia and bragging about biased studies funded by the AANA are getting old.

  10. Ayesha K says:

    Very well put Dr Newman ! Your unique experiences in the military and civilian healthcare give you a rare insight of different roles.
    To the NP and PAs getting offended by this , instead of conflating your inadequate micro training, your time would be better off getting actual experience in treating patients in training before you are given license to practice, the way no doctor can practice without doing a residency.
    Doctors are not in charge of your teaching and should not be expected to teach you at your jobs … while taking on more liability themselves.

  11. Dr Z says:

    Perfectly describes the current situation in corporate medicine today. If you want to see a doc these days (rather than an NP/PA) you have to fight an army of med corps, receptionists, and ancillary staff.
    Sick medical system.

    Thanks for your courage to speak out against this fraud. Americans deserve first rate physician care. They should be empowered to demand it. We already pay for it with expensive deductibles and insurance rates. We should not accept less.

  12. Dr Z says:

    Perfectly describes the current situation in corporate medicine today. If you want to see a doc these days (rather than an NP/PA) you have to fight an army of med corps, receptionists, and ancillary staff.
    Sick medical system.

    Thanks for your courage to speak out again this fraud. Americans deserve first rate physician care. They should be empowered to demand it it. We already pay for it with expensive deductibles and insurance rates. We should not accept less.

    • Mamadoc says:

      Recently called my dermatologist (whom I have known for 30 years plus ) and was told I could see the PA next week or wait until June to see the doctor. I told the receptionist I would be happy to wait for the doctor, it’s dermatology for pete’s sake and is there any such thing as a derm emergency anyway? Besides, that PA grew up across the street from us (we were SO glad we he left home and took his motorcycle and loud expleteive-laden music, both of which went on late into the night, with him). He was a nasty kid and I suspect is a nasty man. So just no. Not in a million years.

  13. David G. CRNA says:

    Respectfully, it’s quite ok to share your opinions on what and how you think this industry should function. The reality is you have no published data to back up significant lapses in public safety as it relates to expanded roles. If you did, you would cite them.

    As a Veteran, you also knew the importance and self reliance of advanced practitioner colleagues in the military. They served as primary caregivers in austere environments, as well as helped in VA and DOD healthcare models to expand much needed care. As a Vet and APRN myself, I think your condescending and disparaging self righteousness is unbecoming. It would undermine the mission, simply because mission readiness and duty is reliant on trust and teamwork.

    Healthcare has evolved to meet the growing needs of the public. Many roles have expanded over traditional roles, whether you like them or not. You can’t wish the Genie back in the bottle no matter how hard you try, and creating a campaign of fear only goes so far before it undermines public trust.

    So much time, money, and effort are spent politically and professionally to undermine your non physician colleagues, those you know you depend on a daily basis. They may not be MDs but they are vital in their expertise, knowledge, and skills.

    So instead of spewing your thoughts on a highly nuanced and dynamic evolving healthcare model, perhaps you might understand the roles you all serve together to improve the care you give. Instead of fighting perhaps you align your resolve for collaboration so you might take a seat at the table to negotiate how you get reimbursed, instead of arguing over who should get the scraps.

    You’re angry because of the system, but you haven’t quite understood your role in it. That takes humility. Chances are you probably rely on PA and NPs in your practice, and I’m sure your comments would undermine the relationships you have, thus impacting care.

    I’ll be happy to share your thoughts across all the media platforms, and encourage my friends to do so. Perhaps you might get what you desire, perhaps you won’t.

    It’s ok to post thoughts in a somewhat protected and limited social space with like minded individuals, it’s quite another to release it broadly so the world can see it. The good news is I’m happy to help you.

    Stay safe and thanks for your service and your accomplishments!

    • Douglas Farrago MD says:

      I will let Dr. Newman answer this. As soon as the militant and extremist remarks start then they will be deleted

      • Nunya says:

        Thank you for allowing this forum.
        It is true that corporate greed has watered down standards for patient care. The saddest part is that patients have NO CLUE who is treating them. That has to change. Patients deserve full transparency. Got your NP degree online while working full time?? Patients should know that.

    • Pat says:

      “… highly nuanced and dynamic evolving healthcare model…”

      It would be more succinct, and far less devious if you just said “education and training don’t matter.”

      • Benjamin Van Raalte says:

        remember all of these “practitioners” first made their argument to the legislators, that because of their less training, they could be less expensive and lower health care costs. That is how they got the votes. That and saying they would provide more access. Physicians have longer training, and more costs and should be paid at a higher rate. Yet, later we find most of the midlevels are not in rural areas by themselves, and they then request that they be paid the same as a physician for the service.

        • Jesse L Belville Jr,PA-C says:

          As a PA-C for 43 and 1/2 years,I have worked most of my career in Rural environments. When I started in 1976/77 PA’s made 12 to 15,000 per year. family practice doc doing OB made 250grand a year. No OB 150 to 165.
          43 years later PA’s out of school first year make 80 to 100 grand,some less,some more. I currently make between 120 to 150 a year. FP’s make 165 to 225 grand a year maybe more or less. Depends on private practice, group, hospital rvu’s or other schemes to deprive you of fair compensation.
          I am a PA-C, Physician Assistant-Certified. Primary care,family practice,Rural ER unless I can avoid it and on call stuff.
          Under the Supervision of an MD or DO. That is how I want it. How I was trained. Yeah I am a former combat medic,and PA for infantry battalion too. In combat…. I want a health care system where we can all work together/learn together with the goal of providing the Best Care we as individuals and a Team can. No I don’t like being criticised behind my back. If I screw UP then TELL ME. If not , swallow your bile and MOVE on. I ain’t your enemy. I am there to help you and others on the team. I choose to be #2.. If I want to be the MD or DO then I will get into Med School. I like being a PA-C. I like supervision and Learning every day. My choice,No regrets. Love what I am doing as a PA. Will continue it as long as brain and body hold out. I turn 70 this year..

    • Benjamin Van Raalte says:

      There is a huge difference between a CRNA level of competence and an online NP program, or others who do just a weekend course. I doubt a CRNA would endorse an online CRNA program. CRNA are highly capable due to both the competitiveness to get into the program, the prerequisites for applying, and the 3 year training. Online or weekend courses that dont have sufficient prerequisites, are not competitive other than writing a tuition check, and are under pressure to graduate those who wrote a check are not. Weekend courses are even worse. I dont think this essay was getting into the CRNA issue with independent practice, but more of the decrease in standards for new pathways.

    • Natalie Newman, MD says:

      Let me be clear. Any threats to myself and my job that result in punitive or injurious measures to my person or livelihood based on your discontent with my material is actionable. I will not hesitate to avail myself of those resources. I am a writer and as such my free speech is protected under the First Amendment. The fact that you dislike my opinion, and it is an opinion based on my experiences, is irrelevant to me. You are typical of many of the CRNAs I have encountered on social media who seem to have a fixation in threatening and harassing female physicians, perhaps to compensate for your own inequities. Perhaps not. In any case, that is for Dr. Phil to evaluate and not me.

      I do not and will not ever support the unsupervised practice of mid level practitioners. Ever. Anyone who practices medicine without completing medical school, residency and possibly a fellowship, is practicing medicine without a license. Nursing is not medicine and should not be assumed to be equivalent. My experience in the military was exceptional and so was my service. My teams worked well both stateside and abroad because everyone respected each other’s roles. No one attempted to perpetrate something they were not. Mid level providers were indeed considered “independent”; however, I was still ultimately responsible for the soldier or dependent as the medical officer in charge. And my team acknowledged and respected that. It did not diminish their role one iota. Do not equate what happens in the military to the civilian sector, it is apples and oranges. Medics have a certain amount of autonomy that would never be acceptable in a civilian environment because it is what is necessary to complete the mission. Their civilian equivalents, PAs, have much more rigorous academic and clinical standards they must achieve before earning their degree. We are not at war nor are we preparing for war when we are working in the civilian sector. Bottom line: your comparisons are invalid.

      Contrary to popular belief, physicians do not have to agree that mid level practitioners can practice unsupervised or “independently”. NP practice was never designed to be independent. Neither you nor anyone else can force them to change their perspective because it does not suit your agenda. Medicine is medicine, nursing is nursing. Respect the differences. By conflating them, you disrespect both disciplines by not acknowledging the unique contributions each brings to the team. It is essential you never forget that only one of us has a license to practice medicine. No one is preventing you from completing the same pathway physicians have for over 100 years if you wish to become a physician. This is America the free. You can achieve whatever you like.

      Authentic Medicine is a public magazine, it was meant to be shared publicly. By sharing, you can only help its distribution. We appreciate your assistance.

      Lastly, my face and name are public because I have nothing to hide. Apparently you do in your effort to intimidate. Take note that your threats have been archived. Anything posted is discoverable.

      Now you have a good day.

      • Kurt says:

        I admire your authorship here. Hit the nail on the head and the ball outta the park. Go Natalie go.

      • Pat says:

        (Loud applause!!!)

      • Jesse L Belville Jr,PA-C says:

        excellent cogent response to CRNA..
        Thank you

      • Proud to be MD says:

        Stop threatening individuals because you don’t agree with them, David CRNA. Please do share this article, as it reflects the deep seated beliefs of many, both within the House of Medicine and with the public. I don’t know about the House of Nursing– that is your House, but most people I know want the most educated individual possible taking care of them. Facts are facts and MLPs/APRNs/ or whatever other term for “Not Physician” you want to spin are NOT the most educated person on or off the team. You are the cheapest. And THAT is why administrators and others want you on the “team”; your lack of in depth knowledge also allows you to be more readily manipulated into providing care that is not standard, generating more $$ for those in power.

      • Keto T says:

        Very well written. Agree with this wholeheartedly. Unfortunately, this is what’s become the “norm” for many. If they don’t agree with you than they start to intimidate you and threaten you.. this is what bullies do! Shameful indeed. I wish people would just move on if they don’t agree with an opinion or an article instead of making a point to bully the authors and others who would agree.

    • Dr. J says:

      Respectfully David, as you accuse the author of not being nuanced enough, I find it ironic that you yourself have failed to grasp the main messaging behind Dr. Newman. Nowhere did she say she was against NPPs, but many physicians are against NPP practicing OUTSIDE THEIR SCOPE (get the specifics?) of their practice. Instead, you gaslight her entire response and reduce it to her inability to function as part of a team (which you have absolutely no evidence for or against).

      There have been numerous studies done that have shown a difference between NPP and physician care, to claim there are none is disingenuous and being intentionally obtuse. And before you cite the one oft-quoted publication that supports CRNA and NPP level care being equivalent, know that that one study has been criticized and overall determined to be a poorly done study.

      Your entire response comes across completely as gloating that the VA has now allowed CRNA independence, with absolutely no substance behind it while hiding behind a facade of “Aw shucks, can’t we just play nice?”.

    • Arwen says:

      David G. what country do you live in?
      “It’s ok to post thoughts in a somewhat protected and limited social space with like minded individuals, it’s quite another to release it broadly so the world can see it.” ???
      I don’t even understand that comment, unless it’s a threat, which is super classy. Ironically, you are on here releasing your mansplaining and condescending drivel for the world to see, too. (“You’re angry because of the system, but you haven’t quite understood your role in it. That takes humility.” Priceless. The humility is just dripping off the statements you’re spewing here, isn’t it?)
      Physicians unfortunately have NOT spent time or money or effort defending our profession, which is what allowed well funded NPP lobbyists to talk politicians into legislating privileges which have not been trained for.
      And by the way, genies automatically return to their bottle once they’ve granted the wishes of their master, so you might want to rethink your use of that particular idiom. 😉

    • Sheetal P says:

      To the CRNA who responded..I am an anethesiologist and I am 100% in support of what Dr.Newman wrote. I take issue with what you wrote that “healthcare has evolved to meet the growing needs of the public. ” Sadly it has evolved only to meet the bottom line for administrations. The needs of the public actually have not changed. They need physicians when they are sick. Pretty simple. By not providing more residency spots for physicians ( blocked by lobbying by several mid-level organizations for many years) there was an artificial shortage created and artifically “filled” by mid-levels and now they want to claim equivalency. The lobbying and gross misrepresentation of themselves is what is hurting healthcare. If everyone stayed in their lane we wouldn’t need articles like this. And please, for your own sake, don’t ever tell a female physician “You’re angry because of the system, but you haven’t quite understood your role in it. ” I can assure you ANY female PHYSICIAN damn well knows her role in the system. We have fought tooth and nail and have brought down significant barriers to know our role and please don’t think for one second we will let just anyone walk away spewing what you just spewed. Unbelievable.

    • Dee says:

      I think every patient values a good RN at their bedside. A good RT. A good dietician etc. What they don’t value is doing to the hospital or office to see a doctor and not seeing a doctor and being TRICKED. It’s not that Midlevels don’t have a role in the new “evolving” system you describe. But their role should be under a physicians guidance to stay in their scope which is nursing and always have to work with a physician to take the bear, safest care of people.
      Honestly, smart and driven RNs can keep their RN and be easily trained to help under a physician with midlevel tasks.

      There’s nothing fancy or magical about a modern Midlevels degree except apparently an extra class in hubris.

    • Alexandria says:

      David G CRNA sounds like someone sounds bitter he didn’t make it to medical school. Her post is nothing short of absolute truth. Bet you yourself wouldn’t want your kids life in the hands of yourself or your colleagues. Every NP I’ve ever met has only wanted to see MDs… ever wonder why if they’re so equivalent?! Because the honest answer is they know they don’t know enough… and that knowledge is what makes or kills. Why shouldnt the public be privy to the same insight?

    • Cullen W Burke MD says:

      Someone didn’t get into med school.

    • Lydia Perez says:

      As a concerned citizen, I say there is no need to cite anything! Do your own research! The data is out there! I wish more doctors would speak the truth as this one.

  14. L. J. Sloss, M.D. says:

    You are such a sorehead! Next thing you know, you’re going to be complaining about faith healers!!

  15. Steve O' says:

    We have all seen the medical establishments of the world, at least the establishments which belong to Academic & Corporate Medicine, get caught with their knickers down.
    When there is a respiratory pandemic, especially one that is transmissible, the hospitals need a second tier of crosstrained physicians – not gas-passing PA’s – as the ICU staff burns out – and this goes TRIPLE for crosstrained ICU nurses. The chance of a for-profit system sponsoring this depth-of-coverage is nil.
    The care you describe is no different than other Upper Third World countries, where the pharmacist is the prescriber, and anyone with a shingle can claim any expertise. This is what they do in the Lower Third World countries. We, however, are able to devise phony statistics, like the USSR’s ever-increasing wealth and productivity reports, until it collapsed. We will look jealously at the Turkish heathcare system in a few years, now that the statistical clothing has been stripped from the emperor, and we are competing with Iran and Libya for what we have to offer. In other words, we are lowering standards because we have no hope of maintaining them.

  16. Jesse L.Belville,PA-C says:

    As a Physician Assistant-Certified with almost 44 years experience in Primary Care/Family Practice,Rural Health. Thank you.I am for a PA or NP being part of a team,headed by anMD or DO. I was trained to do the routine things,assist the Physician,taking care of routine so my Physician had more time for his more complicated patients, thus improving access to care, improved quality of care,more timely care.. Did not work out that way. Instead I was treated and expected to perform as a physician just at a much cheaper price. Over my 44 years I have had only 2 or 3 physician’s who acutally cared enough to supervise and educate me..You are where you are because of Politics,which many of you ignored and others took over health care.. Everything is a business model. Everything is ruled by the bottom line..
    Now gather your forces in all 50 states plus territories and change things 1 legislature at a time. You will also need 1 billion for each state cause it will be one hell of a fight.. Watch the headlines for NP’s /PA’s being sued and take your friends in the press and go after them for their incompetence,get the law changed.You write the legislation,state and Federal.Then move it forward.. Remember to never stop cause as soon as you relax it will start all over again.
    Yes I have said the same to my state and national PA societies, they tell me I am too old and don’t understand.. Yeah unfortunately I DO and it is playing out as I expected.. But fight the good fight,if you cannot change it get it modifed,.. Good luck,

  17. Benjamin Van Raalte says:

    It started within our own profession. As a board certified plastic surgeon with 7 years of surgical residency I’ve spent the last two decades competing against people who decided they were burned out and with a weekend course could become a plastic surgeon. When we complained our fellow physicians said it was just a turf war or we were rich surgeons. All we are good for is plastic surgeons is emergency room call mostly unpaid because we don’t have clout and all those pseudoplastic surgeons don’t have to take call. We were ignored by our fellow physicians at that time and yes you reap you sow.

    • Natalie Newman, MD says:

      Thank you for your response.

      I trained at a time when there were a lot of cross-trained docs. ENT did some plastics. Gen surg did endoscopies/colonoscopies. Ortho did some hand. IM did some GYN. But they all had formal training in those areas and clinical experience. They also knew their boundaries. As EM, I absolutely object to my colleagues who open medspas performing dermatologic procedures or liposuction. That was never within our scope as EM trained docs. When complications occur, then those same patients are sent to the specialists they should have gone to in the first place.

      Medicine, in general, has a culture of demeaning each other. We have to stop it. We all traveled the same road until we reached residency. It takes all of us years to become experts in our craft, so why are we so critical of each other? I was guilty of it when I did not recognize just how much primary care physicians had to know which is ridiculous considering I rotated through IM and FM as a resident. It’s inherent disrespect. If we want to see change, we have to begin with correcting the behavior within ourselves.

      I belong to a grassroots patient advocacy organization; however, we are also physician advocates. We support DPC and private practice. We have a physician-only mapper for patients who seek physicians care only. For docs who use MLPs, we support those who supervise appropriately and do not use their MLPs to perform initial consults. If a colleague sends a patient for consult, that colleague has determined that what is needed is beyond his/her scope so the patient is sent to the specialist. There is nothing more disheartening than to have that consult then turn over that initial evaluation to a MLP who is not an expert in anything medical. That is not respecting a colleague’s assessment, it is being dismissive.

      One of the originating members of our organization is a plastic surgeon. She has her own successful practice. Members refer to each other as well. We have a job board for any docs who lose jobs for speaking out about the encroachment of others into our fields of specialty w/o the appropriate education and training. If you would like to know more, please send a message privately to Authentic Medicine with contact info(ie: FB or email) and I will happily share more. If you have a private practice, we can add you to our mapper. I can promise you, you will not be ignored.

      • Ben Van Raalte says:

        Thanks. I agree. Quite often we get called from the ER by a NP who wants us to suture a 1 cm laceration. The patient did not request it, the NP suggested it because they dont “feel comfortable”. They also dont understand the reimbursement has been changed to the amount of time an ER doctor spends and is already there, and his overhead, not the specialist driving in, spending 2 hours of time, not paid for call, and huge overhead.

        • Natalie Newman, MD says:

          I don’t understand…when did compensation for call cease?

          I left EM two years ago for a multitude of reasons, one of them being I was tired of supervising NPs who were becoming reckless and less receptive to supervision. If I trusted a NP, they had freedom, although I still oversaw their work. If I did not trust them, I was on them like white on rice. They were never permitted to call a consult w/o running it by me first. If the consult asked to speak to me, I got on the phone. I did the same with PAs. I had much less issues with PAs who are amenable to physician supervision, are very procedure oriented and function well in the ED. Now they have all but disappeared from the ER landscape.

          If you, as a plastics consult came in, I would make sure your tray and supplies were set up and the wound cleansed. Many consults might be pissed at being called in, but once they saw how I worked, a mutual respect developed. The annoyance came from them being called for nonsense, being given half-a**ed information and nothing being ready when they arrived. No one ever set up my tray like they had in the past, I do it myself. No one cleans the wounds anymore, they don’t know how. But I still extend that courtesy to my colleagues, it fosters a good relationship. I’m sorry you don’t feel appreciated and respected. I hate that my specialty has all but turned over EM to NPPs, something I never thought I would witness. It’s depressing.

          • Mamadoc says:

            Hell, my group (family medicine) was never compensated for call. We were supposed to take all the drug overdoses, drunks and stuff the specialist didn’t want to admit in exchange for having privileges. After 30 years we decided the game wasn’t worth the candle.

          • Douglas Sprung says:

            You were obviously well trained, well mentored and have been disseminating that training. Never stop just because the masses are doing the wrong thing.

  18. Pat says:

    Way to go Natalie, another great read. You nailed it.

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