The Unsupervised Practice of Medicine–A Crime Against Humanity
In every state and U.S. territory, it is illegal to impersonate a physician. It is a crime. I have long proclaimed that the unsupervised practice of medicine(UPM) by nurse practitioners(NPs) and physician assistants(PAs) IS the practice of medicine without a medical license. It is my contention that those engaging in the UPM are indeed masquerading as physicians and as such, are committing a criminal offense and should be arrested. State laws for both NPs and PAs, specifically the state Nursing and Medical Acts, mandate that these non-physician practitioners(NPPs) must clearly identify themselves to patients. Allowing the patient to presume they are physicians is a violation of state law as they would be misrepresenting themselves as physicians–by omission. In my opinion, even if they identify themselves correctly, they are still in breach of the law if they practice medicine unsupervised because they are not qualified to do so. I don’t care if UPM laws have been passed, I still maintain that imbecilic legislators have legalized what remains illegal on the books. In other words, these fools have passed laws that are contradictory to the state laws around impersonating a physician. As far as I am concerned, every state with UPM is a crime scene.
It is popular for NPPs, in their fight to achieve the unsupervised practice of medicine, to claim that state regulations and supervisory requirements, which were designed to protect the public, are outdated and restrict their practice. So what? Those laws are supposed to do exactly that–prevent their practice from encroaching into the field of medicine, especially without supervision. NPPs are not physicians. For the record, laws intended to protect the public are NEVER outdated. NPPs whine that they should be permitted to practice at the “top of their license”; however, they have yet to define exactly what that entails–because even they don’t know. It is exactly that opacity that creates a legal loophole for them to so casually expand their scope of practice into the field of medicine. It is a very effective marketing ploy that resonates with legislators who then empathize with their faux victimhood and give the NPPs what they want–the ability to practice medicine WITHOUT the requisite training, WITHOUT oversight and WITHOUT a medical license. In what other universe can anyone with a master’s degree practice medicine unencumbered?
Neither NPs nor PAs are equipped to practice medicine independently; their education and training are nowhere near sufficient for what is necessary to be proficient in the practice of medicine. PAs have some medical education, as their curriculum includes some courses in medical school. Makes sense that they are trained in the medical model since their entire discipline was created, in 1965, by Eugene Stead, MD, to work symbiotically with, not be independent of, physicians. Dr. Stead based his PA model on the collaborative relationship between a physician in rural North Carolina, Dr. Amos Johnson, and his assistant, Buddy Treadwell, who had worked together since the 1940’s.
Nothing has changed in the PA curriculum that suddenly makes them capable of practicing medicine without supervision. Nothing. This is exactly what was alluded to at a 2017 Physician Assistant Education Association(PAEA)forum regarding Optimal Team Practice(OTP), aka the unsupervised practice of medicine. The PAEA is a national organization representing PA educational programs.
“PA education is built around curricula that prepares graduates to practice medicine with physician collaboration,” Kohlhepp stated in his testimony to the House. “If PA programs are to produce graduates to practice with full practice authority, we will need to educate them differently.”–William Kohlhepp, former president of PAEA
To their credit, the PAEA recognized that for PAs to practice unsupervised, current PA curriculums would have to undergo a major overhaul to support independent practice. The American Academy of Physician Assistants(AAPA) sought to have practice without the involvement of physicians until the PAEA put a stop to it and they were forced to modify their position. But they didn’t stop seeking OTP, even in its modified form. They then did what the NPs did, hustled their way over to their legislative sugar daddies to make it happen. And they succeeded in getting the UPM in at least two states.
Ironically, the first nurse practitioner program was also founded in 1965, by pediatrician Henry Silver, MD, and nurse Loretta Ford, EdD. Their collaboration resulted in a pediatric nurse practitioner program created to increase health care access to children and families in rural and urban areas. Dr. Ford valued her roots as a nurse.
“Don’t forget that you are a nurse,” she said. “Don’t forget the human interaction, that’s what helps people.”–Loretta Ford, RN, EdD
There is no doubt that Dr. Ford would be disappointed with the degradation of NP education today. What human interaction is there with some NPs obtaining their entire education online and their “clinicals” primarily consisting of shadowing? From March 2018-January 2019, 20,000 NPs were released into the workforce. In no way can one conclude with that volume, that every single one of those NPs graduated from a highly competitive, top-notch program. In fact, the majority of NPs graduating today are from online degree mills. Their programs lack structure, standardization and quality. These “grads” are unable to function as RNs, let alone NPs. Nevertheless, they can still practice unsupervised in 26 states. There are no safeguards in place to protect the public from these NPs. These individuals have zero interest in being nurses or carrying on a legacy of what was once an honorable profession. Not one damn thing about their training involves a formal medical education. Their dumba** leadership whimsically concluded that NPs could practice medicine competently because their vocation has now existed long enough for them to have become adept at it. Sure…they must have acquired their medical aptitude by osmosis. Then they attempted to validate that idiocy with trash studies from 20 years ago. No self-respecting researcher or academic who reads those “studies” would consider them anything but garbage. Hell, not one NP can articulately defend even one study. Yet, the NPs pushing for the UPM have miraculously managed to persuade moronic legislators that that nonsense suffices as valid evidence of their “medical expertise”. To add to the crap studies, they now have a crap “doctorate” that is easily obtained online. They then have the audacity to claim comparability to other doctorates such as the PhD, MD/DO, DVM, DDS, DPM, etc. A preposterous claim since their Doctor of Nursing Practice(DNP) isn’t even in the same orbit as the other doctorates, nor is it a clinical degree. There’s a reason only 6% of NPs have a PhD…because it takes work. Those seeking that toilet paper degree mill “doctorate” don’t want to work. We know that because they are the same lazy a**es seeking the UPM by legislation and not education.
If I wasn’t witnessing this insanity myself, I would swear I was in some perpendicular universe. Never in my career did I imagine that this would happen in the House of Medicine. That nurses would be ashamed to be nurses and would convince lawmakers they are the same as physicians. Why does no one question how the f**k we could possibly be the same when again, THEY ARE NURSES AND WE ARE PHYSICIANS? It takes physicians over a decade to obtain their education and training so we can develop the expertise so integral to the authentic practice of medicine. Medicine is a completely different pathway and discipline than nursing. Why does no legislator speak to former nurse practitioners, registered nurses or physician assistants who became physicians? If all were the same, then why the f**k go to medical school/residency? Where is the logic in that? Was it that they had an overwhelming desire to go deeply into debt and waste a minimum of 11 years of their life? Or maybe because there is a significant difference in each profession and education actually matters?
I assert that every state that legalizes the unsupervised practice of medicine is committing a crime against humanity. And every legislator, physician, corporate/ PE group or unenlightened other who enables that s**t are accessories to a crime. Increased access does not equate to quality health care. These cretinous lawmakers have CHOSEN to place patients in harm’s way because they made a conscious decision not to do their due diligence and take seriously their responsibility to the public with whose safety they have been entrusted. Unfortunately, it is they who are and will be the true victims of this lunacy known as the unsupervised practice of medicine.
“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”
Guess it’ll take one of said legislators or one of their family members to have a bad outcome.
Dr.Newman;
Very Good. Thank you.Keep fighting.Organize in EVERY STATE,FEDERAL FACILITY, NATIONAL ORGANIZATIONS.ALSO EVERY CORPORATE HEADQUARTERS, LEGAL SCHOLARS,AND LAWSUITS.. It will take all that,cause the Nursing powers that be , want to take you out..They want to Run Medicine. So do Some PA’s. Ain’t Qualified. Talk to any RN/NP or PA who has gone to med SCHOOL. THEY WILL AGREE WITH YOU. I do. GOOD LUCK and GOOD HUNTING..
When do you think we will get a Flexner Report of Nurse Practitioner programs?
Natalie, EXCELLENT piece. It seems to me that corporate medicine, which is taking over the world and wants lower level and lower paid “doctors”, is fueling this push. Just this week, I see ads for a mobile ER service, which is staffed with “the equivalent of what you find in hospital ERs”. I assure you that they are not talking about actual physicians. And you refer to moronic legislators. Redundant, Natalie. GREAT work today!
I find an interesting question to ask a new nurse practitioner graduate. I ask them if any of their professors had legs. The vast majority of them have only seen them on zoom and, shockingly, more commonly even than that, they only see them on YouTube video presentations of lectures. They have commonly never even met them in person. These poor graduates know near zero anatomy, did all self study, had to arrange their own clinical hours – I blame the diploma mills, not the graduates. They spend a lot of money in good faith hoping to help people.
I recently had a high school girl tell me she wanted to go to college, get her RN and then go directly to nurse practitioner program route. I literally yelled. For the first time in the HISTORY of mankind women make up more than 50% of med school attendees. So many have worked and struggled and died for this. Go to med school. If you don’t want people to sell you short, don’t sell yourself short.
She is planning on med school.
Thank you for your comment.
I agree with most of what you have stated with the exception that I DO blame the NPs who attend degree mills. They are not helpless damsels in distress-the majority are making a conscious choice to apply to these programs. These are online schools. That alone should be a red flag that is not where one can learn nursing or how to be a NP(online entry-level programs are combined BSN/NP programs). Anyone shopping around for an educational program has a responsibility to do their homework. If a program expects the student to arrange their own clinicals, that also is a red flag. The information about these for-profit degree mills is well-known and has been commented on by at least one former president of the AANP. The NPs who attend these programs do so because the only other alternative is to apply to a competitive brick-and-mortar NP program that requires more time investment. So they take the path of least resistance. Then they graduate, get certified and go work in your local ER. I’m more concerned about the patients they practice on than I am about them.