Dissecting a Lemon: Comments Exemplify Indoctrination (Docs vs NPs, PAs: How AMA Made Scope Creep Fight Uglier)

There is a Medscape article titled Docs vs NPs, PAs: How AMA Made Scope Creep Fight Uglier which highlights the training differences between NP/PAs and physicians. It talks about the lie about mid-level providers going to rural areas. It further discusses the concept of “scope creep.” I wrote about scope creep in a prior blog (https://authenticmedicine.com/2020/11/hey-creep-patients-deserve-care-led-by-physicians/) which seemed to gain a lot of interest and interesting commentary as did this Medscape article. The article also played a self-made video on expanded scope of practice and the triggering of mid-level providers. This discussed autonomy versus physician-led and discussed the infamous AMA tweet:

“Patients win when each member of their health care team plays the role they are educated and trained to play. That includes care led by physicians—the most highly educated, trained and skilled health care professionals.”

(https://twitter.com/AmerMedicalAssn/status/1323403265162305538

The video then referenced the AANP “Open Letter to the American Medical Association,” (https://www.aanp.org/news-feed/open-letter-to-the-american-medical-association) which called the tweet “disingenuous” and “attack.” This open letter was written by none other than our beloved Sophia the Worst: Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, President, The American Association of Nurse Practitioners. The video also referenced the AAPA Response to AMA’s #StopScopeCreep Campaign (https://www.aapa.org/news-central/2020/11/aapas-response-to-amas-stopscopecreep-campaign/). The video points out that the AAPA wrote specifically against physician led care. 

“We would also like to address the AMA’s antiquated concept of “physician-led patient care and training.” This is not only contrary to what evidence shows is best for patients but is also out of touch with how medicine is practiced today. The most up-to-date practice laws allow healthcare teams to decide at the practice level how they will collaborate to best meet the needs of patients. Evidence demonstrates the most successful clinical teams are those that utilize the skills and abilities of each team member most fully, and a team approach supports efficient patient-centered healthcare.”

The video reports that while both NPs and PAs have provided valuable services during the pandemic, items such as the concept of “#Choose an NP” and the push for full practice authority (FPA) exemplify a push to move away from physician-led health care teams. There are also reports of NPs replacing physicians in organizations. The video reports that PAs are not far behind NPs in the push by leadership to move away from physician-led healthcare teams. Lastly, the video discussed the physician shortage as a physician problem to solve which is something I’ve been saying for a long time – fix the physician shortage with more physicians, and do that by increasing residency positions!

What I wanted to draw attention to is some of the delusional commentary such as this: 

It is interesting to read your perspective, and it does show one of the biggest gaps in the argument by using education and hours to support suppression of NP practice.  NP’s are RN’s first, and most have years of practice before returning to graduate programs.  They have a 4 year college degree that focusses on Medicine and 2-3 years in graduate school, which is more focused medical education than most Medical Schools.  In terms of Clinical hours, if you include all the hours from education and the years spent at the bedside, a graduating NP has vast experience that may be well beyond the average graduating medical doctor. You also don’t mention leadership, which can never be taught and is garnered through maturity and experience.  I’d like to hear your perspective on what makes doctors natural team leaders?

Wow, I know right?? Here’s my response dissecting this lemon of a comment:

  1. NP’s are RN’s first, and most have years of practice before returning to graduate programs.  Apples and oranges my friend. Apples and Oranges. (https://authenticmedicine.com/2020/09/fruitology-in-california-the-doctor-is-out/?fbclid=IwAR2c-Mh_mAD-Pg-sfreFwNH6G_PCKjc1rS2c6swraDMDGdbulQr2oaOh7l4)
  • They have a 4 year college degree that focusses on Medicine and 2-3 years in graduate school, which is more focused medical education than most Medical Schools.  Really? In the 15 years I was an RN and the 8 years I was an NP – the education was all the nursing model and not the medical model. It was not medical education. It was nursing education. Having gone through medical school and all USMLE Steps successfully, medical school is medical school and thus medicine. Nursing school is nursing school and thus nursing based on the nursing model. How many nursing theory classes and nursing theory papers I must have written. 
  • In terms of Clinical hours, if you include all the hours from education and the years spent at the bedside, a graduating NP has vast experience that may be well beyond the average graduating medical doctor. Simply delusional! And besides clinical hours of being a nurse can’t equate to clinical hours of medical students, residents, and physicians. 
  • You also don’t mention leadership, which can never be taught and is garnered through maturity and experience.  Really! Delusional again. When I was in the Army, it was all about teaching leadership based on sound evidence-based principles. 

And that’s all I have to say about that.

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