Straw Man: The Dishonesty Needs to Stop

A straw man argument is defined as an intentionally misrepresented proposition that is set up because it is easier to defeat than an opponent’s real argument.”As such, the dishonesty under the guise of promoting a profession needs to stop. My former profession has resorted to the straw man fallacy in arguing for full practice authority (FPA). I have stated previously that I support the utilization of Nurse Practitioners (NPs) on Physician led multidisciplinary health care teams. Utilized correctly, NPs are an added asset. There is however a relentless and zealous push for FPA within the NP community. I’ve practiced in states as an NP with both FPA and required Physician collaboration/supervision. There really wasn’t much difference in what I was and wasn’t able to do. Moreover, when I had collaboration, it made me a more educated, wiser, and safer provider. The argument in the state of California as outlined in EXPANDING THE ROLE OF NURSE PRACTITIONERS IN CALIFORNIA The Impact in Rural Communities1is a straw man argument for FPA. It states:

“numerous studies have found that state regulations that allow NPs to practice without physician oversight are associated with increased access to care for patients, particularly in rural regions and for Medicaid enrollees.”

This statement is not cited with such studies or evidence. As is so often stated: “evidence shows….” “studies show…” and no evidence is cited or provided. Moreover, it is based on the argument that FPA is needed in order to increase access to primary care in rural areas. Ok, first of all, this is not the argument at hand regarding FPA. The question is whether or not NPs should be practicing independently as primary care providers in the first place with FPA. This question is kicked around all over the place in social media and is more often so emotionally charged that objective constructive debate is lost. Opponents of FPA for NPs state that NPs have 3% of the education and training than physicians who are board certified in family medicine/primary care, and thus should not be independent in the primary care practice or even specialty practice such as psychiatry. Proponents of the FPA state that they want NPs to be able to practice to the full extent of their education and training, and to do so will increase access to primary care especially in rural areas. I have yet to see the operative definition of what it means to practice to the full extent of ones education and training. I was an NP for 8 years prior to becoming an MD, and in states with FPA and without FPA, there was little difference. I never did and still don’t know what or how I wasn’t practicing to the full extent of my education or training as an NP, or even what that means. Thus the straw man evolved. Something like this: 

FPA will allow NPs to practice to the full extent of their education and training and will increase access to primary care and specialty services especially in rural areas.

This has completely sidelined the real question as to if NPs should have FPA in the first place. The title of the article even supports this straw man argument inferring that NPs need FPA to positively impact rural communities. Hey California, how about getting back to the real debate on FPA?  



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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 

  1 comment for “Straw Man: The Dishonesty Needs to Stop

  1. Steve O'
    May 25, 2019 at 10:02 pm

    Today, the validity of a narrative is of no interest. What matters is the exciting potential of the future, an infinite new unreality in which any sort of magical wonderland can be created.
    The myth is that everyone knows what medicine is and what doctors do, thanks to the internet. One becomes an assertive consumer just by claiming an equal say in one’s healthcare to the establishment, personified by the practitioner.
    Of course, the unlicensed practitioner or midlevel practitioner are the equal of the so-called “doctor.” All one has is to believe it. Home birthing with midwiffery is equal to the hospital with their “specialists.”
    Those that already have all these options with none of the vision, the Third World, energetically pursues what we are rejecting. Families will incur great expense to have hospital births – what are they thinking? They can buy medicines over-the-counter in local pharmacies; why do they persist in having doctors? Why do they celebrate having a town doctor in places which have very experienced medics?
    They are burdened with their understandings of reality. And they have slower internet access.

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