The Emperor Has No Clothes-The Case of Physician Imposters in the Time of COVID
COVID-19 opened a Pandora’s Box that exposed to the public many of the deficiencies in health care that healthcare professionals(HCPs) already knew existed. Finally, the public was able to see just how dysfunctional the U.S. “health care” system really is–on the inside. Physicians, nurses and other HCPs continue to be terminated and/or have their careers destroyed for complaining about issues that affect patient care and safety. Since the corporatization of medicine, the name of the game has always been to keep the public ignorant to what is occurring behind closed doors. COVID didn’t give a s**t. It unceremoniously pulled back the curtains on the charade of false transparency and contrived compassion by the private-equity backed medical institutions, contract management groups(CMGs), Pharmacy Benefit Managers(PBMs), Group Purchasing Organizations(GPOs), etc. seeking to profit off the crisis.
Unfortunately, the pandemic also conveniently provided fertile ground for unqualified predatory opportunists, also striving to profit, to practice medicine unsupervised by claiming that this blatant violation of the law was absolutely necessary to bestow the care needed during this nationwide disaster. In addition, non-physician practitioners(NPPs) falsely accused physicians of impeding their attempts to assist during the pandemic. Nevermind that NPPs were already working in areas they maintained they could not because they were being obstructed by medical doctors. It was all a lie. A lie perpetrated to achieve the agenda they had sought all along, Full Practice Authority(FPA) and Optimal Team Practice(OTP). Consistent with their unethical campaigns, the pandemic enabled NPPs to expedite a truncated path to play doctor that would appear to the public to be legitimate(as it was co-mingled with the crisis), with the hope that once the pandemic had run its course, their hastily enacted FPA/OTP laws would not be rescinded, ultimately enabling them to effectuate physicians without oversight or real accountability. Imitation is supposed to be the greatest form of flattery. Not in this case. It is a catastrophe of the greatest magnitude because the one’s paying the highest price are the patients. They always are.
It is my opinion that legislators, economists, health care professionals, corporate medicine, etc. do not understand that by promoting FPA/OTP, they will be exchanging one calamity for another. Using physician facsimiles to save a buck will cost more in the long run because this fraud is unsustainable for one reason–the legitimate practice of medicine is not reproducible. However, it is possible to mimic. The proof of quality is in the pudding. That pudding is the public. They will exhibit the deficits in knowledge of those engaging in the illegal practice of medicine. The harm done to them may not be recognized immediately, but it will manifest in some way, shape or form. It is inevitable. The devil is in the details and the NPPs do not possess the details required to practice authentic medicine competently, unsupervised. The goal of the American Association of Nurse Practitioners(AANP) is to achieve pay parity with physicians:
Good luck with that. If the pay and reimbursements are the same, why would any institution then hire those with little to no formal education in medicine and increase their liability? They won’t. Same for those who chose to open private practices. Why would the public, if paying the same price, choose NPPs instead of physicians who are actually trained and licensed in the practice of medicine? Hell, NPPs choose physicians for their own care preferentially. They just want a two-tiered system for everyone else. Logic dictates patients will go where they get the most bang for their buck and save more in time and money since physicians have fewer referrals and order less studies.
Bottom line: NPPs are not physicians and never will be, regardless of the shenanigans in which they engage to deceive the public. Do not be fooled. The emperor is naked people. Naked as a jaybird.
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Ahhhh, I agree. I went through a hellacious residency I won’t go through the details here and was really pretty comfortable handling anything that came across in the rural area I ended up in. At least in the early days (and I was not some cock sure stupid head either). Started out in another specialty in residency, I switched and wasn’t turned loose for five and a half years after med school graduation. Had a decent 30 something year career and glad I was able to retire at 64.
I did have an N.P. later on in my F. P. stint I worked with who did very well. If she had a question, I would fear them because she was so good and anything she came up with was challenging as h#ll. We’d get through it though and the professional relationship lasted nearly 30 years.
She had an upbringing that was unusual in that she was in the “family way” at a very young age. Dumped the dirtball 1st husband after a few years and went through nurses training. Did general nursing for a few years. Went on to oncology nursing for eight years after that and THEN went for her Masters and N.P.
Our rural clinic would get reimbursed “better” if we employed “extenders” in the governments eyes and she got hired I think in part because she lived nearby and would be satisfied working here. The interviewers were right in that she and I had the same lusty sense of humor. Dirty jokes out of patient’s ears were the norm with her having as good one’s as mine! Cripes, as long as it’s in private out of patient earshot it’s not a problem as far as I’m concerned. We got along well professionally.
I have to insist this was a pure professional relationship period. Her spouse was a schoolteacher and mine was a nurse. Standard Judeo-Christian relationships for the both of us and we respected each other professionally. Had a blast doing medicine though during working hours!
We still text rarely in retirement but she and I don’t miss those “old” days too much. She retired before me due to age and the fact her 2nd husband was able to retire from his job as a school teacher. I don’t miss the stress of inpatient care or “call” anymore. That is something my N. P. didn’t have to put up with. She was only supposedly to do “common” and “everyday” issues. Except that some patients didn’t believe in that dictum.
Errrrr, many of my female patients upon finding out that I was working with a “woman” N.P. opted to have their Pap smears done by her as they felt more comfortable with a female doing the procedure. Cripes, that was fine by me as if I wanted to do that stuff all the time, I would’a been a “groinicologist”!!!!!
There are patients who are fixated on not seeing “doctors” and she got hammered with some really complex issues that she very nicely and politically told the patient she needed to get “me” involved. Paved the way for me to see some-doctor-fearing patients and deal with the issue at hand.
Ohhhh, she was good in briefing me on the issue at hand and many times I had to admit the patient to the hospital. Good judgement on her part!
I’m told in one of the hospitals I worked in when I was a resident in the early ’80’s that N.P.’s do all the I.C.U. admissions now and not the residents. That is a travesty as far as I’m concerned.
Kurt
The description of your working relationship with your NP is exactly the type of relationships that used to exist. Explaining to the NPs today, who think they know everything, that the relationship between primary care docs and the NPs of yesteryear were long-term, mutually respectful, professional relationships. I view it similar to an officer and NCO in the military. Both relationships are vital and get the mission done. One delegates and one executes, but both have inherent duties of their own as well. When docs and NPs worked in those relationships, the patients were well-cared for.
It is unfortunate that today NPs are allowed to be hospitalists, staff ICUs and ERs w/o oversight. It is not a coincidence that lack of oversight usually occurs at night, where there are minimal to no witnesses. In areas like the ICU and ER, who would question a death in those environments? So deaths due to mismanagement slip through the cracks. The patients are treated as if they are expendable. It’s criminal.