Garbage In, Garbage Out from the AANP
Don’t you just love statistics? It’s funny when groups use them to dazzle people. Legislators eat it up, especially when it comes from the AANP. Here is a great example that was shared by the group Patients for Patient Protection with us:
April N. Kapu, DNP, APRN has said that after FPA (Full Practice Authority), the number of NPs in rural areas increased in Arizona by 73%. (I am not going into detail about this misrepresentation, the details are in our rebuttal, suffice to say the data actually do not say that.). I recognized some interesting data. Here it is:
Between 2002 and 2013, in the 12 years after FPA, when rural shortages were supposed to be cured by all the NPs running to underserved areas, here is what actually happened. In that period there were 1556 new NPs in Arizona. How many went to the seriously underserved “isolated small rural areas”? (envelope please).
Seven.
Of 1556.
And the number of NPs/100k in isolated small rural has gone from 19 to 24.
While, in the urban areas, this number went from 30 to 51.2. Shall I point out the gap in 2002 was (30-19 = 11), and the gap is now (24-51.2= 27.2). The gap has actually more than doubled.
So a question occurred to me. How many NPs needed to move to the isolated small rural areas to equal the NPs/100k of the urban areas. (51.2)?
Only 30 more. Of 1556.
Over 12 years.
Three per year.
And it didn’t happen.
This is a real-world experiment that shows that their claim that NPs will solve rural primary care shortages has no truth behind it. BONUS INFORMATION – for use in another context. The AANP has as one of its stated goals of increasing NP pay to parity with physicians. On the face of it, sounds like they want to help their NPs. Well., we know that most NPs are employed. We know that employers use their market power to depress NP pay to, at times, less than RN pay. So, any increase in reimbursement will come to the employers. This report contains an interesting statistic. Only 6% of the NPs had any ownership in their practice. The remainder are 94%. Who will benefit from raising compensation for NP work? The answer of course is overwhelmingly the employers.
It is clear they are the real constituents of the AANP.
What did Mark Twain or Benjamin Disraeli say about statistics?
Oh shoot, I supervised an N.P. awhile ago and we had a very cordial professional relationship.
In Illinois, an N.P. had to have a supervising physician so my malpractice insurance would be on the hook too if she messed up. She did good though and always grabbed me and discussed a questionable situation. I can say we had a good work relationship over the years we were together. She retired before me as she was older than me but we still exchange cards by mail and email.
Kurt Savegnago, M.D. (retired)
Oh,
I forgot to mention, NP’s were supposed to be looked at as physician extenders.
If they want to be independent, let’s see how long malpractice insurance providers are going to cover them!!!!
If they can’t ride on a doc’s coattails, they’ll be screwed the minute they get sued for malpractice!!!!
Best regards,
Allen Kurt Savegnago, M.D. (retired)
I’m not a clinician (I’m a researcher). For what it’s worth, which may not be much as my sample size is 2, NPs can work very effectively in Direct Primary Care practices. The ladies that took care of me in that setting were second to none and there was constant communication of all of the clinicians with the DPC physician / practice owner. So I guess you could say they were “supervised” but for what my 2 cents is worth, I think the ability of NPs to provide excellent care depends on the particular NP and the practice culture.
Really, why should we expect NPs to act any different than anyone else? Unless you feel you have a major calling or responsibility to help the underserved, you’ll go where the money is.