I Am Pro-choice for Patients

From 2016 to 2017, nurse practitioner (NP) certificates issued in the U.S. doubled. This rapid production was sparked by the Academy of Medicine’s idea to expand the scope of practice for non-physicians to as an answer to the physician shortage. The authors of the Affordable Care Act took this advice and carved out a section of legislation to push states to give NPs lawful rights to practice without the collaboration or supervision of physicians. With this green light, the American Association of Nurse Practitioners has successfully lobbied 23 states, the District of Columbia, and the VA to essentially allow NPs to practice medicine (that is, examine, diagnose, and treat) without a medical license. Organized think tanks supporting this idea equating NPs with physicians, fund campaigns and shape policies of both Republican and Democratic lawmakers. These policies have lead to NPs saturating markets in urgent care clinics, emergency departments, ambulatory clinics, and hospitals. Large Pharmacy Benefit Managers, like CVS Caremark, have seized the moment and created instant medical care centers staffed mainly by NPs.

It is arguable whether or not this has improved patient access to medical care services. However, what is most concerning is whether some patients actually have a choice in who they see when they seek medical care. As a member and president of the grassroots physician group PHYSICIANS FOR PATIENTS, I see and hear a growing number of stories where patients show up to or call for an appointment with a physician and are told they must see the NP or PA (Physician Assistant) first. Some patients say they are told the NP or PA is the same as a medical doctor. In some instances patients may not even get to see a physician during the visit. I also have physician colleagues telling me they refer a patient to a specific sub-specialist and their patient is forced to see a non-physician. Essentially, the patients are being told they don’t have a choice in their own medical care. But, patients should know they do have the right to choose the type of medical care personnel they see. There are several laws and statutes to protect patients’ rights to choose. Do you know them?

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Nicole Johnson MD

Nicole M. Johnson MD is a practicing physician in Cleveland, Ohio. She received her medical degree from Case Western Reserve University School of Medicine and is certified in General Pediatrics and Pediatric Critical Care Medicine. Dr. Johnson is the President and Co-founder of PHYSICIANS FOR PATIENTS®, a grassroots organization that champions physician-led care and fights against the unsupervised practice of medicine by non-physicians. She is passionate about lowering the cost of medical care for all Americans, solving the physician shortage, and ending mandatory Maintenance of Certification®. You can follow her on Twitter, Facebook, and LinkedIn. Also visit www.physiciansforpatients.org. 

  11 comments for “I Am Pro-choice for Patients

  1. mamadoc
    May 30, 2019 at 10:21 pm

    Several times I have referred a patient to a specialist, only to find that they were evaluated by a midlevel and never saw the doctor. That’s not what I referred them for. So I stop referring to that specialist then and there.

    • Nicole M. Johnson
      June 5, 2019 at 9:48 am

      Good for you for redirecting your referrals and good for your patients.

  2. Steve O'
    May 28, 2019 at 1:14 pm

    Notice that all measurements used in management are the simplest ones, so that they can understand them. For most health managers, there is the following timeline – access, encounter, documentation. The clinical visit, as they see it, is not too dissimilar to that as understood by a four-year-old. The doctor sees them, listen to their chest, says “umm-humm” and writes a prescription. [and, of course, enters reams of the trivial and normal into the electronic gaping maw.] The quicker and cheaper these ‘encounters’ can be staged, the more money comes to management.
    It is possible to do all this, as we know, without knowing anything much about “healthness.”
    As to the inference to “pro-life,” perhaps we should get it on, making our severely inhumane culture more supportive of humans, rather than yell in legislatures about fetal heart tones.

    • Nicole M. Johnson
      June 5, 2019 at 9:54 am

      Agree about the corporatizing of medicine. Unfortunately, employed doctors just comply to stay employed. The ones who don’t, get forced to leave.

      As for the pro-life inference, there is none and no mention of fetal heart beats in my piece, but since you went there, we should also make sure the living human ball of cells gets to make a choice also.

  3. Rebekah Bernard MD
    May 28, 2019 at 10:30 am

    Thank you for writing this and speaking out. Patients are having the choice of physician-led care stripped away by corporate interests – they must become aware of this risk. Great job Dr Nikki!

    • Steve O'
      May 28, 2019 at 1:21 pm

      But they have been sold this garbage for thirty years, starting with the shocking misuse of the study To Err Is Human by the IOM, to portray Corporate Healthcare’s own “Gleiwicz incident” as an excuse to blitzkreig through American medicine. In self-defense of course.

    • Nicole M. Johnson
      May 30, 2019 at 8:10 am

      Thank you Dr. Bernard. That is my hope.

  4. PW
    May 28, 2019 at 9:36 am

    If course it’s not about access to care, it about providing a cheaper and more compliant type of practitioner to keep revenue up for hospitals and urgent cares.

    • Nicole M. Johnson
      June 5, 2019 at 9:56 am


  5. May 28, 2019 at 7:57 am

    Kudos Dr Johnson! Patients deserve the right to know the training of the clinician caring for them. Sad that corporate medicine is trying to cover that up by equating mid level providers with physicians. Nurse Practitioners have a role in medicine, but they do not practice medicine. They practice Nurse Practitionry. For so called Free Market think tanks to suggest that equating the two is a free market idea is absurd, and is dangerous for patients who may have a clinician who doesn’t know what they don’t know. Stellar NP should be just as concerned. More info on Dr Bernard’s excellent article here: https://www.kevinmd.com/blog/2018/01/independent-practice-nurse-practitioners-physicians-outraged.html

    • Nicole
      May 30, 2019 at 8:08 am

      Thank you Dr. Mass. Agreed.

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