The Secret: Why Physicians Were Never Supposed To Know About Scope Creep
I have written many articles about scope creep and the unsupervised practice of medicine by non-physician practitioners(NPPs). It is no secret that I belong to a patient advocacy group, Physicians for Patient Protection(PPP). When I joined this organization in 2017, they were just a Facebook group of approximately 2500 docs, most in primary care, who had begun a dialogue about patients they were seeing in their offices, clinics or emergency departments who had been mismanaged. That alone was not abnormal. What was odd was the disproportionate number of mismanaged patients being seen. Unprecedented. It is not uncommon that when docs notice an unusual trend or pattern occurring in their clinical practice, they are compelled to investigate and ask questions. By nature, we are not only curious, we like to find the answers to those questions that explain what we are witnessing.
It is typical to ask a patient who he/she sees for their primary care. The majority of these patients had physicians. At least that is what they believed. This fledgling group of docs had basically three questions. Why were they seeing an excessive number of these mismanaged patients, why did some of the cases involve errors that even a medical student would not make and who were the physicians managing these patients? Since physicians are required to protect the public as mandated by their oath(and the medical boards of their respective states), they had an obligation to report these physicians in some of the more egregious cases. In addition, they also wanted some clarity as to why these docs were providing substandard care. And that is what they set out to do. It was around that time that I was invited into the FB group by an emergency medicine colleague who was a member. I shared my own experiences as an EM doc who had witnessed the same issues with patients and as a result had stopped supervising NPs four years prior. This fledgling group of PPP members eventually discovered that the doctors seeing these patients were in fact, not physicians, but NPs with Doctorates of Nurse Practitioner(DNP) degrees. None of us had ever heard of this degree. It was also sometime during this early period that PPP stumbled upon the online NP “degree mills” and a then unknown entity known as “full practice authority”. PPP FB reached out to other docs across the country to assess whether this was a regional or national issue. It was national. The docs contacted were educated on the issues with NP education and FPA. Many decided to join the FB group to get more information. The PPP FB group subsequently became an official patient advocacy organization which has swelled to 12,000 plus members.
Once we began exposing the travesties that are full practice authority(FPA), the degree mills and the sham doctorates, the backlash by NPs was swift and vindictive. Many of us were attacked online, doxxed, threatened, stalked, called vile names, our places of employment contacted in attempts to have us terminated(and some docs were) and harassed incessantly. Initially, I was both intrigued and baffled by this overreaction to our action. For decades, physicians and nurses have always worked in teams and our practices have been complementary. Collaboration existed, despite the current rhetoric. Speaking for myself, my presumption was that the NPs who heard about our concerns would be just as incensed as we were. That was not the case. They became defensive and angry. It was a couple of years, after more research, reading and having obtained information about the Institute of Medicine’s paper on the “Future of Nursing”, that I had a light bulb moment. I elaborate on this campaign in this article written for Authentic Medicine(https://authenticmedicine.com/2020/09/the-metamorphosis-of-medicine/).
In that moment of clarity, I understood that no one was ever supposed to know about this dark side of NP education and the real purpose of the “Future of Nursing”. No one was ever supposed to discover the degree mills, FPA, which would allow all NPs to practice without oversight or accountability, regardless of training, as long as they were certified or the DNP degrees that permitted NPs to refer to themselves as “doctors”. No one was supposed to know that NPs supporting FPA desired parity with physicians without actually becoming physicians. Instead, the NP and nursing organizations, WHO KNEW about these substandard degree mills, WHO KNEW that the graduates from these subpar programs were not well-trained, WHO KNEW of the entry-level programs NPs, who had never practiced as nurses or NPs(only to work unsupervised and without accountability in FPA states), WHO KNEW the majority of those DNP degrees were not clinical and would be used to deceive the public, made a conscious decision NOT to inform the legislators, from whom they sought legislative support to achieve equitability with physicians by passing FPA, of these matters. Unfortunately, they forgot one thing: What is in darkness always comes to light. Enter Physicians for Patient Protection. We inadvertently shined a spotlight on the matter.
Physicians knew none of this was occurring. PPP stumbled upon it. Our intent was to inform and protect the public and physicians. For that we were vilified and the NPs who were duplicit in maintaining the “secret”, with no way to defend the indefensible, contrived a victim role, deflected and gaslighted. They spun the history of PPP as forming solely to “attack” NPs, rather than acknowledge the actual roots of its formation, which was patient safety. In my opinion, their exaggerated, vehement response was the manifestation of the shame and guilt they felt at being exposed. What one would expect from an uncontrolled diabetic caught with his hand in the cookie jar. They simply were not prepared for the exposure. But now we know. Since their leadership has chosen to do nothing in regards to the issues discussed in this article, PPP will continue our advocacy as we always have and do right by the people. Patients first. Always.
***THIS COMMENTARY CONSTITUTES ONLY THE OPINION OF NATALIE NEWMAN, MD. IT DOES NOT NECESSARILY REPRESENT NOR SHOULD IT BE CONSIDERED AS REPRESENTATIVE OF THE VIEWS OF THE PHYSICIANS FOR PATIENT PROTECTION ORGANIZATION***
What bothers me about the nonphysician practitioners is how the doctors get forced to assume medicolegal responsibility for them.
William Bebout’s experience is all too typical.
Headline from Texas Medicine today, 11/11/2020
VA Waives State Scope Laws for Nonphysician Practitioners
The U.S. Department of Veterans Affairs (VA) is waiving state scope-of-practice laws in an interim rule that takes effect today, effectively allowing VA nonphysician practitioners to practice across state lines at VA facilities without physician oversight.
A few years ago, I worked for a big entity Hospital organization as an employed physician. I was forced by this organization to “supervise” NPs. The problem was, there was no supervision. They were allowed to practice independently with the understanding that they would seek my advice on patient care. They never did because they felt they were adequately “trained”. I was never comfortable with this and I was proven right when one of my patients had to see this NP do to over scheduling. He saw her for a mole he had noticed on his back. She told him it was no big deal and she would refer him to dermatology. That was the end of it. She never followed up, had me look at it or checked up on him. He didn’t think it was a big deal and never went to dermatology. He came in to see me 6 months later with a tumor on his back that was at least an inch in diameter and length and penetrated 22mm. Yes, malignant melanoma. He died last year. Nothing ever became of it. She was quietly released from employment after many complaints but she rapidly found another job in a neighboring city. This situation made me sick and is the primary reason why I try to educate patients that NPs and PAs are not doctors nor are they equivalent.
When people are sick, they are desperate. They are bound to be mislead. There will be many disasters. Big Med is hiring mid-levels to provide services at a cheaper cost than real docs. In the rural area I practice, docs are hard to come by. We cannot blame our patients for their ignorance. Last week a patient related a story about how the PA-C at the local dermatology clinic was about to remove a rapidly growing tumor from her leg. For some reason she contacted her breast surgeon at the cancer center 2 hours away and sent him a pic. He immediately contacted a colleague who regularly deals with skin cancers- this was a squamous cell. They got her in a couple of days later. And when she called the derm clinic to cancel her surgery appointment, they told her she shouldn’t be taling advice from a breast surgeon about a skin lesion!!!
You speak for this Family Doc! Shine on!
My colleague Dr. Newman,
Bureaucracies and other evil institutions cannot last in the presence of success. Their task is to punish failure, and if there is not enough failure, they will contribute to it.
In America 200 years ago, when persons claimed to own other persons, the purported owners were not complimentary towards the purported property. They were cruel and contemptuous, in order to keep their human chattel in-line. The man on horseback was not riding through the cotton fields saying “Great job! Keep up the good work! I’m proud of you!”
Today’s overseers must have some sort of failure which they corrected, in order to justify their jobs. The JCAHO reformed (and changed its name, often a give-away) because they were only passing without corrections some 5% of the hospitals which they reviewed, an absurd percentage that not even JCAHO could bully through.
Big corporate medicine needs awful things to criticize, and if it can be snapped up by the press, so much better. The overseers of the New Medicine need something to oversee. Hiring vain people with spurious titles, for what those people believe are cushy salaries, is critically useful to Big Medicine.
Big Airlines cannot follow these rules, because the NTSB considers mass death of airline passengers to be an anomaly and a bad thing. In medical care, everyone dies sooner or later, so the airline industry can’t go trolling for pilots the way they troll for “providers.” Big Air is instead using Artificial Intelligence to reduce the cockpit crew from three to two, and next to one pilot. They hope to make the leap to the unmanned AI plane sometime within our lifetimes. So is Big Medicine. They will ditch the providers with inflated egos, and replace them with robo-medicine. Our 21st century guiding phrase will be “Oopsie!”