Not So Fast

A few weeks ago I highlighted how the AMA came out with a position statement declaring health care teams should be led by physicians.   Take a look at the post here.  It seemed reasonable.  It seemed logical.  The editorial even pointed out this information:

In March 2012, Virginia instituted a first-of-its-kind law that can serve as a model to other states on how to formally recognize physicians’ role in leading health care teams, and the abilities of other professionals to deliver care up to the standards of their training. The law specified that nurse practitioners must practice as part of patient care teams that are led by physicians. The law also increased from four to six the number of NPs an individual doctor may supervise, and removes a requirement the NPs and the doctors regularly work at the same location, giving the option of using telemedicine to collaborate. The result is that access to care is expanded, particularly in underserved areas, in a safe and effective way. The AMA plans to use the Virginia law as a template to develop model state legislation.

That law, by the way, was hammered out with the state NP group being involved.  It was a long and tedious process. “The Medical Society of Virginia and the Virginia Council of Nurse Practitioners collaborated for nearly two years on the effort. In doing so, they found that they were able to work toward common goals, said Michael Jurgensen, the society’s senior vice president of health policy.”

I ended my 1/21 blog by saying, ” Is this heresy to state that physicians should lead?  I am sure there are a lot of midlevel organizations that are pissed right now.”  Well, I was right.  Here is what Angela  Golden NP, president of the American Association of Nurse Practitioners, said about the AMA statement:

Regarding “Health care teams must be led by physicians”: Your editorial reflects a point of view that is out of step with new and evolving health care delivery models, and the current and future health care needs of the country.

The overlapping and complementary skills of today’s diverse range of health professionals make hierarchical, physician-centric structures unnecessary. In fact, they hinder health care access, a major issue as states look to address the shortage of primary care providers and simultaneously prepare for increased demand for health care services stemming from implementation of the Patient Protection and Affordable Care Act.

Instead of seeking to maintain the status quo, the American Medical Association and other leading professional associations should support efforts that empower health professionals to practice to their full potential and put patient care needs first.

Out of step with new models?  Remember, they agreed to the Virginia law.   This editorial just shows that they, as a group,  DO NOT believe that doctors should be higher in the hierarchy.  And that is extremely important.   To be fair, this is the just the NP organization talking and not the PAs (who are much better about this).    I also love how they once again use the shortage of primary care doctors as a way to claim they have equal ability to treat.  They are hijacking this crisis just to further their own cause under the guise of putting “patient care needs first”.

So, I am the bad guy for bringing up how nurse practitioners want to compete and not just collaborate?   They are offended that the AMA thinks doctors are on top of the medical chain but I can’t push back on this without being accused of some type of discrimination because I use the term LELT?  Child, please.   That editorial by Angela Golden could have eased a lot of fears by being more appeasing (they did agree to the Virginia law) but instead she did exactly what I have said the NPs have been doing all along.  I, for one, won’t give up the fight.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “Not So Fast

  1. Madelyn Sieraski MD
    February 22, 2013 at 4:46 pm

    Every time I read something about this topic I think about the generalist of the past? Only one year of internship than out into practice. Quickens the time from medical school admission to practice. Schools are already increasing the clinical time in medical school. My understanding that is more training (BS/BA + MD/DO + internship) than PA’s and NP’s (BS +two years). Isn’t that what is being recreated?

  2. William Harrington
    February 21, 2013 at 10:12 pm

    I am a patient. Although I have the highest respect for nurse practitioners I cringe at the thought that there may not be oversight by a certified physician. I may be castigated for this but I use an analogy of a highly trained and skilled auto technician being allowed to design and order prduction of a fine automabile.

    • Doug Farrago
      February 22, 2013 at 7:23 am

      The sad part is that you, even as a patient, are afraid to say that. Would you like your next flight to have a Pilot Assistant as the only one flying the plane?

  3. mamadoc
    February 20, 2013 at 9:23 pm

    These people are a cancer.

  4. Bob
    February 20, 2013 at 2:30 pm

    Great article, Dr. F!

    As a PA in Virginia, I wholeheartedly agree with you. No, it is absolutely not arrogant or any other such thing for physicians to be the top of the food chain in medicine. It’s just the way it is.

    On another note, has anyone noticed the trend for hospitals to call midlevels “Advanced Practice” providers? I don’t doubt that an NP is practicing at an advance over basic nursing (so, is it still nursing, or is it medicine? If so, is she practicing medicine without a license? Isn’t her license from the nursing board?). On the other hand, what is PA practice “advanced” over? Maybe it’s an advance over a Medical Assistant… As a PA myself, in comparing my medical training and practice to those of a physician, I am not arrogant enough to call my practice “advanced”. We need a better term. “Physician extender” sounds too much like Hamburger Helper, or some soy product.

    🙂

  5. Lee
    February 20, 2013 at 1:04 pm

    In West Plains the NP’s were calling themselves nurse-physicians…………the State Board put a stop to that thankfully. The scariest thing about nurses trying to practice medicine is that many of them don’t know what they don’t know. Either they don’t care about their limitations or just don’t have the education to recognize them. Physicians need to stay on top of this and not surrender their leadership roles. I recently corresponded with an NP who had a PhD. She continuously referred to herself as “Dr”. I found that quite offensive.

    • Doug Farrago
      February 20, 2013 at 1:32 pm

      Agreed. And it is offensive. Spread the word about this website as I have been on top of it.

    • arf
      February 20, 2013 at 3:32 pm

      Lee makes an important point, the Medical Boards **DO** pay attention to this sort of thing.

      When a nurse holds himself/herself out as a “physician” or by medical interests…..and YES, I HAVE seen nurse practitioners call themselves “cardiologists” and similar, because of an interest in certain diseases……send it on to the Medical Board. They take a dim view of such fraudulent advertising.

      A nurse holding out to the public as “doctor”, or “physician”, or by a medical specialty like “endocrinologist”, “rheumatologist”, etc., is already defrauding the public. If that nurse is unethical with patients by mis-stating credentials, why should one expect that nurse will be ethical with respect to any other aspect of patient interaction, treatment, financials,etc…..?

  6. Pat
    February 16, 2013 at 10:14 am

    Hehehehehe…the minute I read this naked grab of a letter, I knew you would be all over it.

    So we want to get rid of “hierarchical, physician-centric structures”? Any of you NP apologists want to defend this?

    Given these pathetic turf grab attempts, how exactly would the N.P. lobby encourage more med school applicants to fill the growing shortage of…never mind, dumb question.

    • Stacy RN
      February 21, 2013 at 6:18 am

      A nurse practitioner is an advance practice *nurse*. Not a doctor. I have weighed my options of both pursuing the DNP (Doctorate of Nurse Practice) and the MD. I’ve settled on the DNP, but I won’t fancy myself a doctor unless the education becomes equivalent and the licensing comes from the medical board and not the nursing board. Sure I want to pursue a specialty, but that still will not make me a doctor. No matter how you spin the yarn, the DNP is not an MD or DO. If the NPs want it to be equivalent, there’s a long road ahead of improving the education not just for advanced practice nurses but registered nurses as well. (And for the doctors reading this, I’m sure you’ll agree with me that 90 percent of the nurses with whom you work are poorly educated, poorly informed and ought not to be anywhere near the title “Doctor”.)

      • Pat Conrad
        February 24, 2013 at 11:59 pm

        Hear hear.

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