Let’s get Ready to Rumble………… Main Event: AMA, AAEM and AAEM/RSA vs AANP

On July 8th, 2019, the American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA), along with the the American Academy of Emergency Medicine (AAEM), sent an open letter (1) to the AMA: “Where is the Public Campaign Advocating for Physicians?”  The overarching concerns were:

  • (a) the recent advertising by nurse practitioners advocating for their independent practice
  • (b) public campaign challenging physician education and compassion
  • (c) that the American academy of Nurse Practitioners (AANP) is suggesting that nurse practitioner (NP) care is equivalent or better than that of a physician.

The notion put forth is “NPs and other midlevel providers do not have the training required to sufficiently care for patients independently, only trained and board certified physicians do.” The AAEM position statement (2) states“the role of nurse practitioners and other midlevel providers is one that should be supervised as members of the patient care team.” This open letter was requesting the American Medical Association (AMA) take up the cause and advocate for all physicians as the unified physician voice. They urge the AMA to lead a sizable public endeavor, including:

On July 10th 2019, the AANP wrote an “Open Letter to the AMA, AAEM and AAEM/RSA(3)” to retract the above mentioned open letter (1). The rational for the retraction request was listed as “riddled with blatant inaccuracies and self-serving statements that seek to undermine the NP profession and devalue the health care needs of patients nationwide.” It then goes on to describe these inaccuracies as

  • (a)their campaign did not challenge physician education
  • (b) they did not sponsor the slogan “brain of a doctor, heart of a nurse
  • (c) 50 years of research clearly demonstrate, the “brains” of NPs drive health care outcomes equivalent to physicians, year in and year out,
  • (d) collaboration with physician is an unnecessary bureaucratic burden on physicians, NPs and their patients, and barriers, needlessly driving up health care costs and inefficiencies.

It then goes on to describe:

A vast majority of health consumers — two out of three patients — support policies and legislation that remove barriers to NP practice.

I’m not going to argue a position here, but instead will ask readers to decide their opinion. Who is adversarial here? Who is being combative here? Who is attacking who? Who is factually dishonest here? The two exceptions I take to these open letters is I would like to ask the AANP to cite and show the “50 years of research,” and the data showing “the vast majority of health consumers…..”

I’ve seen too many times these words thrown around with little backing, or when the research is reviewed it is lacking, biased, or methodologically flawed. I’ve written about this research a number of times and it’s almost perfunctory to use these words with little backing. As a former NP, I really wish the AANP wouldn’t take such an adversarial position. As an MD, I wish the AMA would take up the issue and push back against what amounts a hijacking of roles and of a profession/discipline from another discipline. Have a great day. 

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  4 comments for “Let’s get Ready to Rumble………… Main Event: AMA, AAEM and AAEM/RSA vs AANP

  1. Jesse Lee Belville,PA-C
    July 18, 2019 at 9:17 pm

    Yes it does Well said NN

  2. Dave
    July 16, 2019 at 12:57 pm

    I feel proud that the AAEM took this on, and is just one more reason why I carry FAAEM after my professional title! I doubt you would see ACEP (which is nearly as bad as the AMA) putting this out…

  3. Jesse Lee Belville,PA-C
    July 15, 2019 at 3:34 pm

    Yes, NP’s and Nursing is trying to TAKE OVER medicine. They are already in Politics in every state, have a national strategy, are pushing at multiple Federal Agencies. May have gotten Parity with MD/ DO providers at VA health system. THIS has been a systematic effort for 50 years. My wife is a1973 John Hopkins School of Nursing graduate and told me then where Nursing was headed,their goals. Nothing I have seen as a PA-C for 43 years has changed my mind. Recently in last 10 years our PA leadership has gone in same direction. Which is WRONG and I have so stated in PA forums. I am A PA-C, my job is to do 70 to 90% of what my supervising MD/DO does, to supplement him, handle the routine cases while he with his greater knowledge takes care of the more complicated cases. Along the way the learning never stops, our skills increase and he or she,the MD/DO has a better quality of life, more family time ,better balance in his /her life, No Burnout. A lifetime of service to community and self. Opportunities to expand services, life, joy.
    Did not happen, Admins, nurses,government took over and now we got a mess.
    Pay attention Doctors or you too will become just another TECH OR cog in this life and joy destroying Machine.. Can you save it? Do YOU want to?

    • NN
      July 18, 2019 at 12:32 pm

      A few of us are trying to take back our role as leaders in medicine. Huge battle when fighting a medical conglomerate, but not impossible.

      It is my personal opinion that the move to OTP was a result of PAs being pushed out of jobs by NPs who can supposedly practice “independently”. What is your take? Many do not understand that NPs did have autonomy…in nursing. Never in medicine, that is why they were supervised. However, their brilliant PR allowed the segue to happen. And it was mostly unopposed because no one expected that NPs would try to pass themselves off as physicians. Completely blindsided. And that was our mistake.

      PAs, trained in the medical model, were much better suited to work in the various departments “supplementing” physicians(I like that term). I’m ER and worked with both NPs and PAs. PAs, hands down, are a better fit. And it has everything to do with how each discipline’s curriculum was designed to function within the medical realm. I think the title of each profession says it all.

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