BLIND AS A BAT, MAD AS A HATTER, DUMB AS A POST, DEAD IN THE WATER
Soooooo…….this article regarding nurse practitioners(NPs) in Canada was published on December 15, 2022. It is clearly reminiscent of nurse practitioners(NPs) pursuing the unsupervised practice of medicine(UPM) in the United States. Both are striving for–pay parity with physicians. The American Association of Nurse Practitioners(AANP) made no bones about that being one of their primary goals, after achieving unsupervised practice. The entire movement of UPM is a lesson in mad hattery.
BLIND AS A BAT
The AANP believes that patients will choose nurse practitioners as their primary care provider. Sure. If that were the case, there would be no need for large medical institutions, community/urban hospitals, clinics, etc. to engage in the good old “bait and switch”. That is, assure patients who request a physician that they will be scheduled to see a physician. When the patient shows up for their appointment, a nurse practitioner or physician assistant walks into the room. The people scheduling the appointments know exactly what patients mean when they request a physician…but they do this s**t anyway. They lie, for their employers who represent the corporations that run hospitals. Why lie if NPs are who patients prefer? Because NPs are not what most people prefer. Given a choice, the people’s preference(including non-physician practitioners themselves) is physicians. Period. So the unethical NPs, with the blessing and support of the predatory and whorish corporate practice of medicine(CPOM), remove the patient’s choice…by lying or frankly misrepresenting themselves as medical doctors. Scope of practice lines are intentionally blurred, enabling NPs to practice medicine without a license. They refuse to acknowledge that they are being used as pawns by the CPOM because they are cheaper. As long as it satisfies their agenda of being considered analogous to physicians, why should they care that they are being used? They foolishly believe the hype of the corporate ho’s and predatory degree mills, neither of whom is qualified to draw such conclusions, that they are indeed equipped to practice as physicians. Hmmph….there are none so blind as those who will not see…
MAD AS A HATTER
Again, NPs seeking UPM do so because they believe their care is equivalent to physicians. They must be bats**t crazy. Why the logic that nurses and physicians are, in fact, not the same and therefore cannot provide equivalent care is ignored escapes me. Nevertheless, NPs continue to quote “studies” that they themselves cannot even interpret. Instead, they parrot what their leaders in the AANP and other nursing organizations tell them the studies say. And they actually believe that bulls**t. Pin them down and ask them to clearly delineate which part of whatever study supports whatever they claim and they simply cannot do it. The reality is this, every nursing board in every state refers to nurse practitioners as advanced REGISTERED NURSES. Because that is what they are. Nurses. With master’s degrees. Not medical doctors. Some nurse leaders pushing for the unsupervised practice of medicine recognized that a nurse with a master’s degree, claiming to be comparable to a physician, would not be accepted by the public. For good reason–because it is absurd. So they came up with a plan to address that inconvenient truth…
DUMB AS A POST
In 1978, the first Doctor of Nursing(ND) degree was launched at Case Western Reserve University in Ohio. It was a 3-year program which subsequently became a 4-year program. However, it didn’t last because the same curricular issues that are present now occurred then, inconsistency and lack of standardization. But they at least tried to develop a program of quality. The online DNP toilet paper garbage degree that exists today is another pathetic attempt for it to be considered similar to other legitimate doctorate degrees such as MD/DO, PhD, DVM, DDS/DMD, DPM, PharmD, etc. Let me assure you, it is nothing of the kind. No effort whatsoever has been made since the 1980’s to create DNP programs of merit or with any semblance of a competitive standard. Degree mills survive because it gives those pursuing those degrees a false, but nevertheless inflated, sense of accomplishment and equivalency to physicians. UPM supporters simply hope and pray that trash “degree” will evoke, in the public, a presumed expertise in medicine, with no questions asked. In their desperation to be considered analogous to physicians, NPs have not only unwittingly partnered with the CPOM/PE debacle, they have become WILLING participants in their own victimization by degree mills whose corporate owners laugh all the way to the bank. And they continue to witlessly pay for that nonsense, trusting that it gives them credibility. NPs desiring convenience consistently follow the path of least resistance and flock to these programs. Why would one pay thousands of dollars to a program that is not providing the education to which it attests? Taking a page from the book of Jeff Foxworthy, you might have attended a degree mill if:
- You had to arrange your own clinical rotations.
- A syllabus is not provided; instead, you were referred to a YouTube page for instruction.
- You believe there is an algorithm that tells you how, when, why, where and what for everything in medicine.
- After becoming newly licensed and certified as a NP, you assume the hiring organization will educate and train you, and you fail to have a light bulb moment and wonder WTF you went to school for.
- As an “advanced” registered nurse(aka nurse practitioner) you have no idea how to place an IV line or read a urinalysis.
Despite all the obvious evidence that these degree mills exist, the denial is powerful. A true lesson in futility. Dumb. As a post.
DEAD IN THE WATER
Private equity and health care corporations are overjoyed with UPM as they can pay less to hire non-physicians to do physician’s work, as well as experience less resistance by NPPs who relish the beloved algorithms of and are less resistant to the corporate practice of medicine. Because the CPOM’s intent was never to prioritize patients–it has always been about quantity over quality. Mo’ money, mo’ money, mo’ money. NPPs fit right into that model nicely. However, I’ve said this before and I will say it again, the unsupervised practice of medicine is unsustainable. It can take years before a bad idea is ultimately acknowledged as a bad idea. The UPM is a bad idea. The Hattiesburg Clinic study showed that allowing NPPs to have their own panels, even with a “collaborating” physician, did not bode well, clinically or financially. And they accumulated data over a 10-year period. In a recent working paper by the National Bureau of Economic Research(https://www.nber.org/papers/w30608), the authors discovered similar findings in emergency departments in the Veterans Health Administration. I maintain that comparable data, with worse outcomes, would be found in unsupervised states. That is, if anyone(ie: nursing organizations, legislators, state licensing bodies, etc., I’m looking at you) ever takes the time to evaluate states that have had unsupervised practice for decades(ie: Oregon, Washington, Arizona, etc.). Current assumption is that long-standing UPM in these states is confirmation that it is working well. Bulls**t. Presumption is not an appropriate litmus test because absence of evidence is not evidence of absence. How would anyone know since no one has followed up care after passage of UPM laws? What IS safe to presume is that anywhere unsupervised medicine is being practiced by individuals without the appropriate physician training and education, s**t will happen. Predictable s**t. Preventable s**t. Avoidable s**t. NPs from sub-standard programs “practicing” medicine are exposing their deficits all over social media, informing everyone of their inability to practice as a NP or faux doctor, in their quest seeking assistance to do what they should not be doing in the first place. Mismanaged patients eventually find their way to real physicians who address the damage done by those practicing medicine without a license. This travesty will continue to grow to the point where it can no longer be ignored–because patients are visible entities. Who sue. And complain. And vote. Then the dumba** legislators who passed these UPM laws recklessly will finally be called to account for enabling this nonsense. Although it will take years before the poor health outcomes of UPM are acknowledged, in due course it will be recognized as the detriment it is to society and it will inevitably fail. And the UPM will be dead in the water.
“When defeat is inevitable, it is wisest to yield.”– Quintilian
