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( 

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.


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