Dumb, Dumber, and Dumbest
In the fight against scope creep and the unsupervised practice of medicine(UPM), it has long been a pet peeve of mine when legislators ask for “proof”, from physicians, that non-physician practitioners(NPPs) have worse health care outcomes than physicians. For one, why are they asking physicians to prove a negative? And second, for us to DISPROVE that nurse practitioners(NPs) in particular, who are trained and licensed in nursing, have the same or better health care outcomes in medicine. WHEN THEY ARE NOT FORMALLY EDUCATED OR TRAINED IN MEDICINE?!! They can’t possibly have the same outcomes. It defies all logic. Legislators make these inquiries with no thought as to what they are asking and how absurd it is. Would they ask attorneys to prove that paralegals have worse outcomes when trying death penalty cases?
“The practice of medicine is the gold standard by which all other disciplines of health provision are measured. The onus is on others, claiming to practice the same, to prove, with VALID evidence of sound quality and unquestionable standards, that their discipline measures up.”--N. Newman, MD.
In the case of NPPs, THAT HAS NEVER BEEN PROVEN. Ever. PAs have no studies, as they are required in the majority of states to be supervised–by law. NPs spout studies from 20-plus years ago that involved supervised NPs, thereby making those studies non-relevant to today. Still doesn’t dissuade brain-dead legislators from asking for this nonsense anyway. It just gets dumber and dumber.
Physicians opposing scope creep must stop going down that idiotic rabbit hole of providing “evidence” because it lends credibility to the non-credible. We should be challenging legislators to do their own homework. To actually read the so-called “studies” that NPs claim demonstrate that their outcomes are equal or better than physicians. Again, how the f**k can their outcomes be equal or better in medicine when they have never been formally trained or educated in medicine? Impossible. PAs have an abbreviated medical education. Contrary to what those seeking Optimal Team Practice(aka the unsupervised practice of medicine) believe, PA school is not medical school on steroids. And even if it were, medical students don’t become practicing physicians until they have completed a MEDICAL internship and/or residency, something PAs do not. No matter how much rhetorical garbage NPPs insist on spewing, there is no short-cut or alternate route to become a physician. The well-known, well-traveled, long and arduous pathway is well-established and has worked for over 100 years. Despite the concept being irrational, plenty of NPPs still continue to believe that they can practice medicine as well as physicians and that the care they provide to patients is equivalent. One more time….since they are not formally trained or licensed in medicine, how the f**k would they know if their care is equivalent? What appears to be functionally the same is not. Since physicians are the experts in medicine, we are the only ones qualified to say whose care measures up. NPPs need to stay in their lane, do what they were trained to do…and be proud of it. It is the safest and most judicious way to practice. Their insatiable need to conflate themselves with physicians implies that they are ashamed of being NPs and/or PAs. Their incessant drive to kowtow to legislators, in order to practice medicine instead of taking their lazy a**es to medical school and completing a residency, is in and of itself, telling. If they are so unhappy with their respective, chosen vocation, then why the f**k become a NP or PA in the first place? It reflects poorly on those who actually desire to practice in those occupations and represent each profession with honor.
Recently a 3-year study of NPs in the ED, using compiled data from the Veterans Health Administration(VHA), was published by the National Bureau of Economic Research(NBER). Conclusion: NPs increase lengths of stay by 11% and raise 30-day preventable hospitalizations by 20% compared with emergency physician. The data period encompassed 2017-2020, the time in which NPs have been practicing without physician supervision or “collaboration” at the VA. I have stated for years that a follow-up study evaluating the quality of care and use of resources needed to be done in states in which NPs have had unsupervised practice for years, such as Oregon, Washington and Arizona. I hold the opinion that none of the nursing organizations, including the American Association of Nurse Practitioners(AANP), will ever perform such a study because they would find exactly what this working paper and the Hattiesburg study found, that NPs do not provide cost-effective care, they overutilize ancillary services such as laboratory and radiologic resources and the care they provide is not equivalent to that provided by physicians. My reaction to both of these studies? Why were they needed for something that is painfully evident? In my opinion, they weren’t. But physicians went down that rabbit hole anyway. Dumb.
I am an individual with a significant amount of common sense. The entire “independent” practice movement for NPPs has never made sense to me and I find it baffling that many legislators and physicians don’t view it as an odd or reckless objective. These people are practicing medicine without the requisite training or a medical license. Yet, what is and should remain illegal is legalized by moronic legislators. And not one numbnut who supports this s**t questions if medicine was so easy, why the f**k is the process to becoming a physician so extensive? That it perhaps indicates that the complexity of the human body should not only be acknowledged, it should be respected. It takes time to know that s**t–people aren’t furniture. The idea that anyone can go online and obtain an entry-level NP degree, take an easy a** exam, become certified, then take their happy, uneducated a** to the closest ER and get hired by the same people who vet my a** to the gills(despite practicing 27 years) is absolutely astounding. And dumb.
“There are some things that do not require evidence because, by its very nature, the answer is apparent.”–Natalie Newman, MD, FAAEM
Suuuuurrrrre, Give the NP’s, NPP’s (or whatever) and PA’s independent practice rights. They can PAY for their own malpractice insurance which is sure to rise exponentially with all the botching up that WILL occur. The hospitalists will freak out. I had an N.P. in the office (as mandated by the administration as the gubbermint would compensate the group better by using “physician extenders!”)
She only did office work and grabbed me all the time for difficult situations. She made good calls and most of the time I had to admit the patient. She was very good with routine stuff and did a good job. I have no gripes.
But……………….. With no supervising doc, what will happen then?
Opinions are like anal openings,everyone has one.. RN’s Have been scheming and planning to Take Over Medicine since before my wife was accepted to the John Hopkins Hospital 3 yr nursing program. She was an RN,stayed an RN.No with her IQ over 160 she did not want to be a Physician,just a damn good RN.. She was. BUT RN’s Play politics, they get into all sorts of positions with indirect influence and Screw with PHYSICIAN’s every chance they get..Many dislike arrogant asshole physicians.. Lots of them.So They play politics so when you wake up one day with the RN’s running your clinics, hospital staff, and Departments who you gonna Blame.YOU LET IT HAPPEN and many of your fellowPHYSICIANS helped.. Ironic Ain’t it…
ORGANIZE IN EVERY STATE, CITY AND COUNTY, ORGANIZE IN EVERY MED SCHOOL,COLLEGE, AND UNIVERSITY.ORGANIZE IN EVERY FEDERAL AGENCY. ORGANIZE NATIONALLY. BUT WILL YOU ?. Your choice.
Me I like being #2 as a PA-C.IT IS WHAT I TRAINED FOR SINCE 1976,45 PLUS YEARS. BUT INSTEAD I WAS USED BY HOSPITAL ADMIN AND PHYSICIANS AS CHEAP PHYSICIAN COVERAGE.. OK I HAD FUN and did NOT kill anyone( to my knowledge.) Saved a few lives as I
did as a combat medic in VietNam..FIRST DO NO HARM.. BUT YOU ALL FORGOT ALL THAT.
DID YOU EVER KNOW IT down deep in your soul? I doubt it. Good Luck, you will need it to save you from yourselves..
We have a weekly contest of the most inappropriate NP referral
They refer and do whatever the patients ask, so they have “high satisfaction ratings”
Yes, do whatever the patient demands antibiotics, narcotics, ADHD drugs, weight loss drugs, referrals and tell them insurance will cover and you are popular. Just like the parent that lets their kids drink beer at 16.
Our winners this month.
A 300 pound woman referred for liposuction
An 80 year old woman referred for wrinkles for Medicare to cover.
and the the clearance for surgery it the surgery is not stressful.
This happened, as with every bad thing in health care, because of the rise and dominance of third party payers. FDR meddled with the market with his obscene wage controls, and the nation was too stupid, too war-shocked to oppose him as employer-provided insurance suddenly became expected. The same generation that fought totalitarianism abroad then hilariously embraced Medicare/Medicaid a generation later, an irony that well-retired geezers 50 years later deny with screams of “I paid for this!,” oblivious to the obvious contradiction to the publicly available accounting; the concurrent federal shackling of state budgets through Medicaid worsened the cycle, and established an additional permanent dependent class.
This all led to the corporate impetus to save money by cutting corners, and the government to attempt (in vain) to battle cost overruns and medical inflation cause by unrestrained demand. This increasingly fascistic relationship between a Big Insurance and Big Government has been a perfect environment for lower standards, and lower-cost care, a gap into which the LELT’s have fit beautifully.
Ultimately, the blame should be on physicians for not en masse refusing Medicare/Medicaid in 1965. And the blame should be on voters for allowing themselves to be so manipulated that they thought their “right” to employer-provided care was worth more than a true doctor-patient relationship, or that they thought the government could ever owe them permanent medical care (exception: veterans).
As with all collective miracles, no one escapes blame. Doctors wanted easy government cash, and lay people wanted cheap, error-free (I wasn’t going to leave the lawyers out), excellent care. As a society, we have all lied to ourselves for almost a century, and the mass acceptance of LELT’s as our equals is the sad, logical, or at least predictable next lie.
If patient seriously believes the medical care they get from an NP or a PA is equal to or better than the care they get from an MD/DO, then they’re getting exactly what they deserve.
I’m not saying NP’s and PA’s don’t serve a useful function, but they absolutely need to be supervised by a physician!!
I wonder how many of the whiz kid legislators have NP’s as their primary care giver??
I’d be willing to guess none!
Yet they’re OK for their constituents!