MUSINGS OF A SCOPE CREEP RESISTER
I find it absolutely preposterous that nurse practitioners(NPs) and physician assistants(PAs), aka non-physician practitioners(NPPs), are offended that physicians do not support the independent practice of medicine–by them. They view our opposition as a personal affront, rather than the fact that what they believe they are entitled to is nonsensical and reckless. It is irrational for them to presume that medical doctors would be amenable to anyone who has never been formally or fully trained in the art and science of medicine, practicing it without a medical license. IT IS NOT SAFE. What is confusing or erroneous about that statement? Why the f**k do physicians, who are the ONLY experts in medicine, expected to prove why those untrained in medicine cannot practice it competently? It was the non-physician leadership who decided, arbitrarily, after many years of being members of a physician-led medical team, that they no longer wished to be on a team in which supervision was mandatory. They wanted the freedom to run amok so they could play doctor without the accountability. It is their false contention that state laws WHICH WERE DESIGNED TO PROTECT THE PUBLIC, are outdated and no longer warranted. To anyone with common sense, it is apparent why that is rubbish. What is true is that the other option, that they do the actual f***ing work it takes to become a physician, is unpalatable. AND THEREIN LIES THE PROBLEM. There are two reasons one would avoid doing the obvious: laziness…or lack of ability.
The first PA program was launched by a physician in 1965 and was NEVER designed for PAs to be independent. Similarly, nurse practitioner programs did not intend NPs to function completely separately from physicians. The first NP program, also created in 1965, was a Pediatric Nurse Practitioner(PNP) program begun by a pediatric nurse and pediatrician who worked AS A TEAM. The genuine, independent practice of medicine is exemplified by the only individuals educated, trained and licensed to practice it. PHYSICIANS. The former president of the Physician Assistant Education Association(PAEA), the only body in the U.S. that represents PA education, gave an insightful explanation as to why they did not support completely removing physicians from the PA-Physician relationship–which was the initial intent of the American Academy of Physician Assistants(AAPA) when it began seeking Optimal Team Practice(OTP). Simply put, he states that for PAs to rise to a level in which they are capable of competent, autonomous practice, their curriculum would have to undergo a considerable paradigm shift to accommodate such a change.
However, that was not financially nor practically feasible. The same applies to nurse practitioners. Their academic programs have not evolved to support an effective transformation to unsupervised practice. Quite the opposite. With the profound drop in their educational standards, independence should never have been on the table, as the proliferation of degree mills would ensure that erudition would not be achievable by graduates of those programs.
Working for decades alongside a physician in a discipline distinctly separate from medicine does not automatically bestow medical expertise. Nor can that expertise be guaranteed based solely on one physician’s opinion, as is common in apprenticeships. Why? Because that opinion would be subjective and the training, only as good as the person doing the teaching. Apprenticeships cannot replace the traditional pathway to physicianhood; therefore, autonomy should not be anticipated because a NPP randomly decides he or she is “ready” to practice unfettered, as the recipients of the casualties resulting from such whimsical thinking and actions are inevitably the public. Physicians who believe that the non-physician practitioners with whom they work are superior to some physicians in practice should know better than to say that s**t since the claim cannot be validated. All physicians have to demonstrate competence by the myriad of written and clinical exams we are required to successfully complete throughout our extensive education, up to and including board certification. It is absurd to demand the highest level of proficiency by physicians, then contradictorily declare a non-physician an “expert” in any particular medical specialty based on a physician’s word or impression–an unacceptable litmus test. It is, however, incredibly egotistical. If the outcomes resulting from apprenticeships had been favorable in the past, there would have been no need for the Flexner Report or the standardized model of medical education that we have today.
The ONLY way to practice authentic medicine is to attend medical school and complete a residency. But alas, rationale does not prevail in the scope creep saga, arrogance and rapaciousness do. Both NPs and PAs have hustled and bulldozed their greedy, immoral a**es over to legislators who don’t know s**t about medicine or why physician education is so arduous, nor do they care. NPPs subsequently obtained approval to practice medicine unsupervised by legislation, not education. Additionally, neither NPs nor PAs made the effort to elevate their academic standards by modifying their educational model, as the effort to complete such a task was daunting for such lazy a**es. They simply added a sham s**t, online, non-clinical, toilet-paper degree that would be worth more if I wiped my a** with it, and sold it as being equivalent to legitimate doctorates. NPs in particular, persuaded the gullible into believing that “studies showed” that their care is the “same or better” than physicians, despite there being no study that showed any such thing. Yet they managed to convince even physicians of that foolishness. Begs the question of how it is possible that an individual trained in nursing, with absolutely no formal medical education to speak of, could have better MEDICAL outcomes than a physician? Well, it’s not possible. Nevertheless, they achieved the unimaginable and now have unsupervised practice in 27 states. The question is, where’s the follow-up on the health outcomes in any of those states since Full Practice Authority, aka practicing medicine without a medical license, was introduced? Anybody? Bueller? Yeah, it hasn’t been done and it won’t be because the findings of an investigation would inexorably reveal similar results to the Hattiesburg study(https://web.archive.org/web/20221213094820/https://ejournal.msmaonline.com/publication/?m=63060&i=735364&view=articleBrowser&article_id=4196853&ver=html5&s=09), just on a much larger scale. Were that to occur, it would be painfully evident why revocation of Full Practice Authority laws would be necessary. Proponents of FPA will not allow that to happen, despite the ramifications to the public. Consequently, NPs will continue to use their 20-plus year old trash studies from which they inappropriately extrapolated data based on supervised NPs, NOT unsupervised, which would have been more relevant.
Here’s the bottom line. Physicians have always enjoyed being part of a medical team and had no desire to disband it. However, NPPs desired dissolution of the team for their own avaricious pursuits. FPA and OTP are completely antithetical to the team approach and provide no benefit for patients. They then had the nerve to be taken aback when docs rebelled against their bulls**t to protect the public from harm, as we are expected to do per our oath, which we take seriously.
When I educate the public and other healthcare professionals about the aforementioned facts, NPPs barge into my Twitter threads squawking that I’m a bully, while simultaneously blathering the “it’s about the team” jibber-jabber THAT THEY SO EAGERLY DISMEMBERED. That, ladies and gentlemen, is referred to as gaslighting. The NPs/PAs who instigate the animus are suffering the backlash of their selfish, disruptive and harmful actions. You reap what you sow.
“Don’t start none, there won’t be none”–African-American colloquialism
Ahhhhhhh. This independent NP/PA practicing if it starts without a supervising physician, will eventually get quashed when the malpractice suits start rolling in. I predict the cases will skyrocket and it will put an end to it as the NP’s/PA’s won’t be able to afford independent coverage without being able to pin the blame on a supervising doc.
JUST THOUGHT MIGHT WANT TO KNOW…………………………………..
AFTER THE MATCH
After the Match
Boosting Profits Drives NP Diploma Mills
Cook, Thomas MD; Adler, Jason MD
Emergency Medicine News 43(2):p 1,35, February 2021. | DOI: 10.1097/01.EEM.0000734568.43890.d0
Metrics
FU1-6
Figure: NP, PA, APPs
FU2-6
Figure
FU3-6
Figure
Roughly 14,000 emergency nurse practitioners (and approximately 10,000 physician assistants) are working in EDs, providing a significant amount of emergency medical care in the United States. But, as we know, this is problematic for many reasons, and now the bar is sinking lower.
Every single person who applied to a nursing master’s program in the fall of 2019 was admitted, according to a U.S. News and World Report article. (June 9, 2020; http://bit.ly/2LGhVgB.) Nationally, the average acceptance rate for nurse practitioner programs is 66 percent. The lowest is six percent at the University of California-Irvine, but the article lists 20 programs that accepted all applicants, half of which had fewer than 30 contenders.
I should like to offer a personal analogy. I would like to express my utter lack of outrage at, once again, being passed over for the presidency of the NAACP for reasons including my lifelong non-membership, but more importantly, I am white as Frosty the Snowman’s butt. I am non-offended that I could be so categorized and excluded. The NAACP has long been a place to gather and share mutuality of the American Black experience in togetherness rather than isolation. I have utterly NO experience in these matters; I am a blind man at the art museum. Perhaps that, not malice, explains my not-nomination to be President. Would I have something to give to the NAACP? Probably not. Could I bring a personal expression of excellence to the Association? Certainly not. Rather, I imagine that members would be annoyed to have an incompetent place-holder as President. I make this analogy not to weep for myself or thunder about my hurt feelings, than to talk about mid-levels. Is it unjust discrimination that they are not equal in independent practice? No. Am I slighted by the NAACP as, yet again, being passed over for the Presidency? No. This organization is 120 years old, and made remarkable progress. For instance, one of my colleagues used to have to go to the Colored drinking fountain while rounding. For real. I have none of these sorts of experiences, but more importantly, I am not qualified to lead the interests of the members. I am so NOT filing a civil rights complaint. That is what I have to say about midlevels.
Really colorful commentary coming from someone self-described as whiter than Frosty the Snowman’s gluteus maximus.
Thank you kindly. I come from a line of nearly fluorescent Irish. We have a negative Fitzgerald score. I never could pass.
Can’t we just understand that these mid-levels don’t need to go to all this trouble? They only need to “identify” as fully licensed MDs. Isn’t that the way things work these days?