REVELATIONS OF A SCOPE CREEP RESISTER
Colleagues, as you fight against this ridiculous scope creep battle, I would like to offer a few insightful caveats/quotes for support.
Be warned that you will be gaslighted and sealioned to death. You will be asked to prove a negative(ie: that NPPs don’t measure up to physicians). Don’t fall for it.
Caveat #1: “The practice of medicine is the gold standard by which all other disciplines of health provision are measured. The onus is on them to prove, with VALID evidence of sound quality and unquestionable standards and methodology, that their discipline measures up.”
We’re the physicians-we don’t have to prove s**t. We put in the grueling work & lifted those heavy-ass books. We are not conflating our profession with others or lying that we can practice in another discipline in which we have not been properly trained. I know of no physicians interested in disbanding the medical team for selfish reasons or any other purpose. Non-physician “leaders” and traitor trash docs will attempt to convince the gullible that non-physician practitioners(NPPs) can do 80-90% of what a physician can do. Those are numbers they pulled out of their a**es. Fiction repeated often enough becomes fact. Again, don’t fall for it. In many cases, less is more. NOT IN MEDICAL EDUCATION. Less is less.
Caveat #2: “Never dummy down, smarten up.”
The importance of education is also why I have this quote in my Twitter bio:
Caveat #3: “Devaluation of education should never, ever be acceptable. Because there would no longer be pursuit of excellence, only pursuit of mediocrity.”
You will be told, ad nauseum, that NPPs should be allowed to practice at the “top of their license”. WTF does that mean? Not one person has eloquently defined the meaning because it’s balderdash.
Caveat #4: “Top of their license is still bottom of the barrel medicine.”
Always remember that the scope creep movement is not about increased access, improving safety or providing quality care to patients. It is about avarice and a lack of ethics. Patients are not on the radar, except as commodities.
Caveat #5: “No one forgets their integrity, they relinquish it.”
Those pushing and promoting the scope creep agenda abdicated their integrity long ago. Had they retained it, this s**t would not be happening.
Caveat #6: “Life is so much easier to navigate without a moral compass.”
I will now exit left.
**All quotes are attributions from Natalie Newman, MD, with the exception of the image at the top of the article.**
This will probably be erased because I’m a PA. I understand that debate isn’t welcomed here.
As a PA with 17 years of primary care experience, I’ve had the honor of working with many physicians who support my role providing care for patients. My takeaways during my career:
1. PAs have always wanted to partner with physicians. We’ve been lumped unfairly into the “Hate all the NPP” group because of some diploma mill NP programs that give the PAs and the good NP programs a bad name. We invite physicians to be our leads, sit on our admissions boards, and teach our students. We’ve ONLY ever tried to partner with docs. There isn’t a single PA program that doesn’t have a physician someway connected with it.
2. Anti PA rhetoric from physicians like this are from a minority of them. The Anti PA (and NP) rhetoric has served only to divide things further. What’s the goal for physicians with messages like these? To feel heard? To get your bad feelings out? To end our professions? Is it working? What’s your goal? If you want to make change, lead our PA programs. The invite is always open.
3. There is data that supports that PAs provide quality care and lower costs, but this page cherry picks the data they want to support their anti PA/NP agenda. You want to design studies that show PAs are awful? Help us design them, many of us like research on the topic and the invite is always open.
4. The cost, length, hierarchical and exclusive structures of MD education that some of you wear like a proud scar have harmed physicians. Burnout, suicide, over specialization, high cost of care, and inefficiencies can partially be traced back to the historical ideas that MD training can never change and that the MD is the god that rules over all. The suicide rate, the number of MDs leaving medicine, and the number of MDs we’ve all met who say they’d never go into medicine had they to do it over again are all signs of a greater ill. You would love to blame these ills on us, but all are in fact a common enemy in the insurers, the administrators, and the old guard that expects you to die on the alter of medical education.
5. I have corrected many mistakes made by clinicians regardless of the letters behind their name. Idiocy and poor clinical decision making skills can be due to poor training, yes – but we all know a physician we wouldn’t trust our mother’s life with. That “calf sprain” that was a classic DVT that turned into a PE and lung infarct? That was missed by the MD and found by me. Did I accidentally save a life? No – I used the same medical model and decision making tools that a physician uses (or failed to use in this patient’s case.)
Keep spewing these kinds of articles. You’re in the minority. You’re bitter, angry, and upset that your careers have led to where they are now. But we could all work together to fight against big business, payers, and administrators. You could partner with PA (maybe NP?) programs to help develop our curriculum and quality guidelines for our education. The door has always been open and there’s always a spot at the table for the docs. That hasn’t changed.
Steven,
You had a lot of passive-aggressive swipes to take, projecting things I never saw mentioned in the essay.
As for debate, I’ve always seen that encouraged here, even as King Doug doesn’t allow unsupported, manufactured LELT outrage.
Question: Did you see any factual problems in Dr Newman’s essay, or are we just dealing with your feelings?
That’s the key. Some LELT groups want “unsupervised” practice ability. That is the ISSUE! If N.P.’s and P.A.’s work with a doc, most outside docs don’t take offense to it. I worked in a group practice that used them to take some of the load off the docs and to a “T” if they were uncertain, they’d bring the problem to an M.D. to discuss. With the N.P. I was associated with it usually meant a direct admission to the hospital as she picked up on a serious problem.
Mark my words, the legal profession is the one that will ultimately squelch this nonsense if it comes to fruition.
LELT malpractice suits will climb dramatically and the idiots won’t be able to afford the malpractice insurance. Too bad patients will get hurt in the process.
There are some patients who want to see N.P.’s because they “aren’t doctors”. I thought that was twisted logic on the patients’ part but my N.P. was empathic with the patients that she wasn’t a doctor and if the patient goes into the hospital, I would be the one taking care of them.
There was no issue between physicians and PAs until the AAPA began seeking unsupervised practice professing they could practice as well as physicians. As an EM doc, PAs have long been a part of that landscape. But they worked with us, not against us. Let us not forget that it was YOUR umbrella organization who sought independent practice(OTP) permanently, in all 50 states during COVID, by taking their opportunistic a**es to Trump and attempting to do it legislatively. It failed. I didn’t see one PA lobbying against that s**t publicly. Not one. The AAPAs actions did enable some PAs to practice medicine w/o a medical license in some states, temporarily. Let us also not forget that it was YOUR organization, the AAPA who in seeking OTP, originally desired complete severance of the relationship between physicians and PAs. NOT PHYSICIANS. The only reason that s**t did not happen was because the Physician Assistant Education Association(PAEA), the only organization in the U.S that represents PA education, was uncomfortable with it. It’s president at the time, William Kohlhepp, stated “PA education is built around curricula that prepares graduates to practice medicine with physician collaboration. If PA programs are to produce graduates to practice with Full Practice Authority, we will need to educate them differently.” A paradigm shift that never happened because it was not feasibly or practically possible, as I outlined in a previous article(https://authenticmedicine.com/2024/01/sub-optimal-team-practice-passes-in-arizona/). You can spout all day that “studies show” PAs lower costs and provide quality care, but none of you geniuses point out the exact studies nor do you highlight the particular aspects of a study that validate or defend your points. That indicates to me that none of you know how to meaningly interpret a study. In addition, had those studies existed, why didn’t Dr. Kohlhepp make reference to them in the aforementioned 2017 statement? The man almost singlehandedly pioneered PA legislation in New Jersey in the ’70s and has been published in many peer reviewed articles. I suspect he can interpret a well-done study. It’s because what you say is bulls**t. I have shared this quote of Dr. Eugene Stead, the physician who created the PA role, many times. PAs who support OTP have decided on the former. Because Dr. Stead designed the role for PAs to be extenders, not independent.
“The PA can have independence at a low level of performance or he can accept dependence and achieve a high level of performance.”
No one lumped PAs with NPs-you all did that to yourselves when your leadership decided to piggy back on the NPs modus operandi of going to legislators, declaring equivalence to physicians, claiming ability to practice unsupervised(w/ no changes in your curriculum) and demanding removal of regulations that were put in place to protect the public. FPA, as it is referred to by Dr. Kohlhepp. By doing that s**t, you made it clear to many physicians you had no respect for us and had zero interest in working with us, just like the NPs. In addition, the moment PAs supported the removal of the safety regulations because you all found them personally restrictive, you lost the respect of a lot of physicians and earned their disgust. At that point, you all decided as a group that patient protection was no longer a priority, your egos were.
So you can f**k all the way off with your sentiments. Don’t you ever bring your gaslighting a** into my commentary until you are willing to challenge and shame your own leadership, publicly, for initiating the enmity and creating the dissension. Again, they wanted to sever ties, not us. Them.
You’re on the wrong website. You need to try crysomemoretears.com
🤣🤣🤣🤣🤣🤣🤣
Ahhh Doug, for fun I tried to find that site and it’s not out there. 🙂
It doesn’t matter about past studies anyway. Even if they did prove. 30 years ago to be a nurse practitioner you had to have years on the job, usually ICU experience. Back then to be in ICU nurse you had to calculate drips meaning you were fairly intelligent.
There were far less women in medical school and thus there had been women who had gone a different career path.
The programs are highly competitive. They were University based with a rigorous curriculum followed by a very rigorous clinical. The intent was for a pediatric nurse practitioner then to do simple well baby exams.
Compare that to now. No clinical experience is required. There is no barrier to entry, you don’t have to be a smart or experienced candidate. The online schools have a weak curriculum. Clinical is virtually non-existent with people scrambling to find people to observe. The quality of the education is copying information on lung cancer from Wikipedia. It’s a level of a high school understanding not pathophysiology.
I have seen nurse practitioners who do not know how to read EKGs. They know less than a nursing student we had in our office at the time.
Essentially today’s nurse practitioner has the same skills as a nurse of 30 years ago. Yet they want to practice independently and be paid the same as physicians. In fact a significant number of their courses are on advocacy.
Agree with Dr. Van Raalte. My N.P. worked as an oncology nurse for 8 years before she got her Master’s and N.P. certification. Was very smart.
Brilliantly said. The noctors, administrators, and insurance/government leeches just need to be told firmly to p€ss off!
Excellent Natalie, irrefutable points and the best way to set the proper discussion parameters. Honest analysis means refusing to accept a dishonest premise, and your points demand an opponent do just that, or shut up.
So maybe a LELT can do “80-90%,” but I think it was Greg Henry who said so succinctly: “It’s that other 10% that makes me invaluable.”