The Art of Bullsh**tery
I hate the stench of bulls**t in the air. Makes me gag.
And right now, with all the hubbub regarding the unsupervised practice of medicine(UPM), the air is awash with some stanky stank, illogical, incomprehensible, crazy-a** bulls**t exploding from every NPP orifice known to man. The GoLytely(or more accurately, the GoHeavily) of bulls***tery. I never knew the human body could contain so much bulls**t. I mean, a Guiness Book of World Records level kind of bulls**t.
Let’s begin with the bulls**t of certain non-physician practitioners(NPPs) just making s**t up. These NPPs have arbitrarily determined that they can do 90% of what a physician does. Ever wonder how they arrived at that number? It’s not evidence-based–it’s what they think. That’s it. And because they think it–it must be so. And just like that, fiction became fact. Now this s**t gets published in all kinds of media outlets as serious commentary. Never mind that none of these heathens have completed medical school or residency. They haven’t the foggiest idea what the actual practice of medicine entails, they just run with their ridiculous claims because they are so vested in maintaining the lie. They then have the nerve to get mad when actual physicians tell them they are full of s**t.
Next line of bulls**t, their assertion that they are whatever “specialist” they proclaim themselves to be, on any particular day. Based on what, you ask? ‘Cause they said so. For example, what qualifies them to be referred to as “hospitalists” or “intensivists” when they have not completed an internal or family medicine residency nor a medical sub-specialty in critical care? Not a f***ing thing. What’s remarkable about the art of bullsh***tery is that it allows one to believe whatever it is one wants to believe. And the nonsensical suddenly makes sense. To the delusional. “Dermatologist” is the most misappropriated professional title of the year 2023 for any NPP charlatan opening a medspa. All of them are so “passionate” about the practice of dermatology and aesthetics, for which they have never been formally trained. However, aren’t they “basically the same as….”? To hear them tell it–yes. Bulls**t makes it acceptable to not know s**t and still be a specialist. Well, isn’t that special….
Another aspect to their bulls**tery? When NPPs say they practice medicine; then, by golly, they practice medicine and everyone better damn well agree. Despite the fact that they have minimal to no training in medicine and no medical license, they actually expect the real experts in medicine, physicians, to concur with their declaration. You see, bulls**t encourages absolute confidence in those NPPs suffering from Dunning-Kruger syndrome or some other deranged malady.
The irony in all this bulls**t is that non-physician practitioners view themselves as the bullied victims in this scope creep mess that they created. The American Association of Nurse Practitioners(AANP), the American Academy of Physician Assistants(AAPA) and the American Association of Nurse Anesthetists(AANA) all decided they no longer wanted physicians to not only not lead the medical team, they didn’t want us on the team at all. So they proceeded to create a scenario to become physicians-by-proxy. Without our consent. They then hauled their lazy a**es over to legislators, ripe for the picking, to become faux physicians by legislation and not education. To seal the deal, they subsequently hopped in the sack with their beloved corporate practice of medicine(CPOM) jump-offs who wanted expensive physicians out of the picture, and proceeded to assist those corporate pimps in replacing physicians with non-physicians. It was a win-win for all those tramps. Physicians had no public campaign or private desire to exit the team or remove anyone else because medicine has always been a team-based profession, with the patient at the center. Those organizations initiated the animosity, then upon reaping the consequences of their behavior by outraged physicians, feigned victimhood and ignorance as to why we would be pissed off about their complicity in displacing and replacing us in our role on the team. Acting as if they didn’t know…after we took them under our wing during their training. Yeah.
Now that is some real traitorous bulls**t right there.
I don’t have a short temper, I just have a quick reaction to bullshit–Elizabeth Taylor
As a PA, I always correct my patients when they call me a doctor. I did not earn that title!
We have a local MedSpa NP in our town, and she is giving weight loss drugs in addition to all the other filler/injections/whatever. Because of her lack of follow up (or care?), we have multiple patients with their BMI now approaching 18. Two of my patients had a starting BMI of 24 and are now at 18. One of our patient’s recently passed out from her weight loss regimen (ended in head lac and a very upset supervising physician of mine), and now the MedSpa just opened a nice, new location on the “nice” end of town. How is this not better regulated?!?!
Their needs to be much more lobbying, oversight or legal changes with these NPs (or PAs depending on the state that allows this) because it will continue to decrease medical quality. Sorry docs, I know you are busy, work hard for your money, but we need physicians to get a better foot in the legal system to stop this progression.
Meanwhile, the wonderful AAFP worries about equity in healthcare and food deserts in the Bronx. Tell me again why we cannot unionize? Something about restraint of trade?
Everything is a business model. I had good to Excellent Physician’s who supervised and trained me as went from student to PA-C. Then as I went to various positions in primary care/ER, amd urgent care I had much less interaction with my Supervising Physician. I often found resentment from other physicians on my supervisor list when I asked for their help or advice.
I was often used by a facility to be a less expensive provider, Very little Supervision. I left several good jobs due to lack of supervision or Physician Malpractice.
You all opened the door to NPP’s. NOW YOU MUST ORGANIZE TO CONTROL IT AND ESTABLISH A CAREER PATH FROM NPP TO PHYSICIAN.I have talked with sevrral PA’s and NP’s that became Physicians. They were stunned at how much they did not Know the info their education left out. Humans are smart ass arrogant critters,often gets in the way of learning and there seems to be a lot of that in Medicine… GOOD LUCK,I hope you can change things.
There already is a pathway for NPP to Physician. It’s the same as for Teachers, Attorneys, Dentists, or anyone else. It’s called Medical School + Residency. If one wants to be Doctor, come in the front door. Granted, it sucks and is a lot of time, money, and grief. Only thieves look for the back door.
My post from earlier today omitted a vital “not.” Please insert where indicated below. Thanks.
Hungry for a provider who seems to LIKE her patients and from the list of conditions listed on her page seems to possess expertise, someone looking for a dermatologist who cares might well NOT see or understand the chasms in her qualifications.
Part of the cause, at least in specialties like dermatology (““Dermatologist” is the most misappropriated professional title of the year 2023 for any NPP charlatan opening a medspa….”), is low reimbursement for wellness and screening visits. That pushes physicians to maximize patient volume, and that in turn can lead to superficial care. My wife and I have NEVER had a truly thorough, top to bottom examination from any of the dermatologists we’ve seen, many touted by “best doctors”-type publications and web sites.
Dissatisfied with feeling like widgets on an assembly line and concerned about a condition that might have been missed, it’s easy to want to cry with relief when you encounter a page like https://doctor.webmd.com/doctor/daisy-fisher-c426296d-060b-444a-8373-f87d545fadc4-overview. You look it over. The reviews are all raves, and a theme that shines though most of them is how well this NP communicates with her patients. That’s not something that physicians are always good at these days, and yes, I know the reasons.
Hungry for a provider who seems to LIKE her patients and from the list of conditions listed on her page seems to possess expertise, someone looking for a dermatologist who cares might well see or understand the chasms in her qualifications. She calls herself a doctor, which she isn’t. She says she does surgeries, which I don’t understand unless she’s talking about trivia that don’t amount to surgery. She never mentions a supervisory relationship with a physician; I haven’t checked Maryland law, but I’m under the impression that NPs have to work under the supervision of an M.D. (And yes, even that requirement has ways of being dangerously stretched.)
Presumably she has to work within the same, or lesser, reimbursement constraints as a real dermatologist, so I don’t know how she spends so much time with patients, as implied, and manages to keep her office open.
Who knows what she might not know? She’s not a dermatologist. But she sounds like one, and puts on an appealing web face. Can you see why patients might respond?
Of course you can. It’s one of the things that makes you crazy. How, then, to get dermatologists to give patients the kind of care that she projects? And how to make her and others like her cease and desist from misrepresenting their credentials and expertise?
Thank you for your thoughtful response.
Yes, I understand why many patients go to NPs when they say they communicate better and spend more time with patients. One reason is those NPs passing themselves off as dermatologists generally have cash-only practices. Most real dermatologists work for private-equity backed corporate medical groups. Next to Emergency Medicine, Dermatology is the most commoditized medical specialty in medicine. Commoditized specialties are volume-based, not value-based. If you were to find a dermatologist who is direct specialty care or in private practice, you would find exceptional care. Because they write their own schedules. Physicians have to work. It takes money to open a practice. With the debt medical docs are saddled with, they end up becoming employees, to their detriment. As an EM doc, I made the decision to leave the U.S. and practice where I can practice medicine humanely w/o some administrator breathing down my neck or threatening me with losing my job because I don’t work the way they dictate. But everyone cannot do what I do. One way the public can help is to write complaints about and to the C-suite rather than the physicians, who actually despise corporate health care. Tell them you demand to have more time with your doctor and that you are not a commodity. Too many patients blame the docs who have nothing to do with the metrics set and statistics kept on every doctor’s “performance”, which is expected to resemble a fast-food joint.
More importantly, my article is to emphasize that laws are being broken and the NPs don’t care. It is illegal for anyone, including NPs, to impersonate physicians. That includes if they allow the patient to think they are a physician. The so-called “dermatology” NPs are not trained in medicine; therefore, who do you think manages their mistakes? The dermatologist. This costs the patient more in the end. No NP in the U.S. is trained or licensed to perform surgery, but they do it anyway. Skin flaps in dermatology are surgery. Liposuction is surgery. NPs, although permitted to practice medicine w/o a license in several states, are not held to the medical standard. They are held to a lower standard which leaves the patients w/o much recourse. In the states that require supervision or “collaboration(which is lax to no supervision”), most are required to identify who that physician is. They don’t. They make it hard on their websites to find exactly what physician is overseeing their care. Because they want people to believe they are the physician. The NPs who open practices purporting to be “dermatologists”, “pediatricians”, “family medicine”, etc. are violating the law. They don’t care. They have determined that what the patients don’t know won’t hurt them…except it will.
The old adage stands: You get what you pay for. No matter how nice they are.
On her web page she actually lists her nursing school as “medical school”
Maryland also allows NP’s (but not PA’s) to practice independently. Caveat emptor.
PhD in (taking the) pi$$ics
I am a Dermatologist and I am sick and tired of all the NPs and PAs who claim to be “passionate” about Dermatology and call themselves Dermatologists after shadowing a real Dermatologist for a few weeks and doing a weekend Botox course. If they were really passionate about it they would go to med school for 4 years then do 4 years of Dermatology internship and residency. But I guess they aren’t quite that passionate to do the proper training and education to provide the best care for patients. I cannot tell you all the missed diagnoses and inappropriate treatment I have seen from midlevels. Not to mention the complications from injecting Botox and fillers that they pawn off on us because they have no idea how to manage complications. When that happens suddenly they become little ol’ nurses again and decide they aren’t the equivalent of physicians when it comes to managing their own complications. They certainly have figured out how to have their cake and eat it too!
Past time to deal with the issue of licensure?!!!
There should no NO licensure by the government. Let specialty boards confer recognition, and let the buyer beware. This would fix a lot of the problem.
I think legislation should be presented that allows law clerks and legal assistants to practice law on their own particularly in areas lawyers don’t want to do like public criminal defense. Once these people can practice on their own they will go into the cash based areas of law that aren’t “in need”. But this should all be totally ok with lawyers since lawyers are the bill of elected officials that think these mid level providers are equal to doctors and practice medicine! Therefore mid level legal assistants should be able to practice law without ever passing the bar or going to law school!!
I was telling a colleague about dumping the ABFM and forever giving the MOC and the prospect of another expensive, pointless, stressful, and insulting board exam the middle finger (moved on to the NBPAS). I was ranting about how Blue/Humana/United/Gov’t, et al, etc treats us as if we are unsafe to treat patients then moment we aren’t “board certified,” and he pointed out how those same entities are happy to take on midlevel LELT’s to do the exact same work without ever having been so certified. Never thought of that before, oh the hilarity.
Exactly. Preposterous, isn’t it?
I have NBPAS as well. This is my last certification with ABEM.
Pitty the poor unsuspecting patients!!!!
WE are the ones who suffer the consequences at the hands of these people!!!
500 hours of “observation” vs my 50,000 hours of clinical training, followed by 5000 nights of unpaid call as an “obligation”, and 35 years in practice , but Google makes them more than equal. Somehow in the first year of opening a med spa they have 150 perfect 5 star reviews.