Patients at Risk: Recent Episodes
Rebekah Bernard MD and Niran Al-Agba MD
Patients at Risk exposes the political maneuvering and corporate greed that has led to the replacement of physicians by lesser trained practitioners, including nurse practitioners and physician assistants. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for our nation’s healthcare guardians continue to decline—with deadly consequences. This is a story that has not yet been told, and one that has dangerous repercussions for all Americans.
The South Carolina Legislature has introduced bills that would allow unsupervised practice to nurse practitioners and physician assistants after 2000 hours of experience, as well as a bill that would expand pharmacist privileges. On the flip side, there's also a bill that would enhance team-based care, ensuring that physicians remain in the lead of medical care and strengthening requirements and enforcement of physician oversight.
Today, you'll hear just a small part of the very, very long two days of testimony before the South Carolina legislature on these bills. Dr. Phil Schaffer and I were invited by the South Carolina Medical Association and we were asked specifically to focus on data - specifically, the evidence to support unsupervised practice.
Take a listen to our testimony and at the end you'll hear a few questions from legislators.
IF YOU'RE A SOUTH CAROLINA PHYSICIAN, please join and support the South Carolina Medical Association (SCMA) - they are working hard to fight for physician-led care. https://www.scmedical.org/
PhysiciansForPatientProtection.org
One patient died and 25 others were found to have been harmed when a nurse was permitted to perform complex medical procedures in the UK.
Gastroenterologist Dr. Kaveh Hoda joins me to discuss the necessary training to perform an endoscopic retrograde cholangiopancreatography (ERCP), a procedure most commonly used to remove gallstones.
From the BBC article: 68 patients underwent ERCPs with a 'single consultant nurse', and a review found that 58 received "substandard" care from the service between 2016-21, including 25 who "suffered some degree of harm". https://www.bbc.com/news/articles/clym224qgdyo
As nurses and PAs continue to advocate for more privileges, could this happen in the US?
PhysiciansForPatientProtection.org
In this episode of 'Patients at Risk,' Angie Pereira shares the heartbreaking story of losing her father due to a misdiagnosed pulmonary embolism by a nurse practitioner in an after-hours clinic. Despite her father's presenting symptoms of shortness of breath and leg pain, strong family history of blood clots, and normal lung exam, the nurse practitioner diagnosed him with pneumonia, leading to his untimely death the next day. Angie emphasizes the need for proper physician oversight and questions the push for independent practice for nurse practitioners. The discussion extends to issues of legislative accountability, corporate healthcare’s role in potentially compromising patient care, and the necessity for patients to advocate for themselves to ensure high-quality medical care. Angie's story highlights the broader implications of inadequate training and supervision in healthcare, especially affecting rural communities.
PhysiciansForPatientProtection.org
Rebekah Bernard discusses the legislative trends and impacts of allowing non-physician practitioners (NPs and PAs) to practice medicine unsupervised. She highlights the extensive training and hours required for physicians compared to the significantly less training for NPs and PAs. Bernard explains how legislative changes have allowed NPs and PAs to practice independently in many states, often with less experience and training compared to physicians. She delves into the history of physician shortage concerns, influenced by flawed reports from the 1980s that led to restricted physician production and the promotion of NPs and PAs as substitutes. Bernard outlines the growth of NP and PA roles, the diluted quality of NP education, and the increasing trend of independent practice. The talk also addresses the disparities in healthcare quality and outcomes when care is provided by non-physician practitioners instead of physicians. Bernard advocates for prioritizing the production of properly trained physicians and ensuring physician-led care as well as holding NP leadership accountable for maintaining educational standards.
PhysiciansForPatientProtection.org
Dr. Denise Weiss always wanted to be a physician, but circumstances led her into nursing. She earned an associate's degree as a registered nurse, and then became a family nurse practitioner. After several years of practice, she realized that her education had not prepared her for independent practice, and she decided to return to school to become a physician. Now a practicing anesthesiologist, Dr. Weiss explains the differences between nursing and medical education, and why physician-led care matters.
PatientsAtRisk.com
Get the books, available in paperback, eBook, and Audible:
Patients at Risk: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Imposter Doctors: https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
PhysiciansForPatientProtection.org
A patient shares her story of receiving the wrong type of filler into her face by a registered nurse, leading to severe and permanent nerve damage. Francesca explains that the RN, who was in NP school at the time, was not being supervised, and worked in a for-profit clinic owned by a non-physician.
While some may argue, "Let the Buyer Beware," Francesca believes that patients are not be in the position to fully understand the qualifications of clinicians being permitted to perform medical procedures, and asks legislators to protect patients like her.
Tell us your story: https://www.physiciansforpatientprotection.org/patient-resources/tell-us-your-story/
Learn more: PatientsAtRisk.com
PhysiciansForPatientProtection.org
In February 2025, the AAPA published a press release entitled: 'AAPA Releases Survey Showing Physician Support for Removing Barriers to PA Practice.' According to AAPA President Jason Prevelige (DMSc, MBA, PA-C, DFAAPA), the survey proved that, “Physicians recognize the need for change. It’s time to modernize these laws so healthcare teams can focus on what matters most, patient care.” But what did this survey REALLY show? Chandani Patel DeZure, MD, joins me to unpack the details.
Links:
https://www.aapa.org/news-central/2025/02/aapa-releases-survey-showing-physician-support-for-removing-barriers-to-pa-practice/
https://www.aapa.org/wp-content/uploads/2025/02/AAPA_Morning-Consult-Survey.pdf
Join us! PhysiciansForPatientProtection.org
Learn more: https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438
PhysiciansForPatientProtection.org
Emergency physician Dr. Deborah Fletcher is an author of the first study to evaluate physician presence in Emergency Departments across the country. She discusses the findings, including that 7.4% of all EDs have NO physician on-site, and of those, 3% have no ability for the NP/PA staffing the ED to discuss patient care with a physician.
Emergency physician Dr. Mercy Hylton discusses the dangers of this practice, including concerns from nurse researchers regarding variability and lack of standards for nurse practitioners working in EDs, and her effort to help Indiana become the first state to require that all emergency departments must have a physician on-site.
https://www.jacepopen.com/article/S2688-1152(25)00008-6/fulltext
https://www.journalofnursingregulation.com/article/S2155-8256(22)00010-2/abstract
Send me an email through the contact link www.PatientsAtRisk.com
PhysiciansForPatientProtection.org
Pulmonologist / Intensivist Gary Dudek, MD, joins me to discuss the CDC's call for comments regarding allowing nurse practitioners and physician assistants to become National Institute for Occupational Safety and Health (NIOSH) 'B Readers'.
B-Readers are highly trained radiologists (medical school graduates with at least five years of residency as well as additional training in this particular type of x-ray) that read and interpret annual screening chest x-rays done on coal, silica, and asbestos workers to look for early signs of a lung condition called pneumoconiosis.
According to radiologists, these x-rays are notoriously difficult to read, and a misread can be a matter of life or death. Dr. Dudek discusses why allowing NPPs to read these x-rays is the wrong decision.
Comment by March 17, 2025: https://www.regulations.gov/document/CDC-2024-0103-0001
PhysiciansForPatientProtection.org
Susan J. Baumgaertel, MD FACP, an internal medicine physician, author, patient advocate, and ally to colleagues discusses how physicians can fight for patients.
Trust in physicians has plummeted in the last few years (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821693), making it more and more difficult for doctors to do their jobs, and potentially leading to a negative impact on patient care. While many point to handling of the COVID pandemic as the cause of growing distrust, a larger part of the problem may be that ordinary physicians virtually no control over the healthcare system or even the day-to-day practice of medicine.
Dr Baumgaertal (myMDadvocate) discusses her fight to help physicians regain the trust of our patients by making sure that they get the best care.
PhysiciansForPatientProtection.org
On September 17, 2024, the Texas Senate Health and Human Services Committee held an interim hearing on scope of practice expansion for nurse practitioners and other clinicians. In this third episode related to that hearing, Texas Medical Association (TMA) president Ray Callas MD discusses the importance of physician oversight for nonphysician practitioners and answers questions from legislators.
Importantly, Dr. Callas notes that in the past, TMA was asked by legislators to 'come to the table' to collaborate with nurse practitioners and to loosen supervision as a compromise to independent practice. But complying with this request is now being used as rationale for removing oversight completely, with legislators arguing, "Well, if you don't need to be on site / can supervise multiple NPs, then are you even necessary?"
Learn more! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
Support our vision of physician-led care and truth and transparency for all medical practitioners: physiciansforpatientprotection.org
PhysiciansForPatientProtection.org
PhysiciansForPatientProtection.org
In the last episode, you heard some of my testimony at the Texas Interim Legislature hearing on Scope of Practice. Today you're going to hear from a nurse practitioner, Holly Jeffries, who is practicing in rural Texas.
Her testimony was particularly impactful and really quite persuasive to legislators. I think it's important to understand the NP point of view and also learn the concerns of legislators by listening to their line of questioning.
Referenced in the podcast:
Facts about NP primary care numbers (HRSA shows much fewer doing primary care than AANP represents): https://youtu.be/AqyUdQZ-9fY
Supervising physicians sued without ever seeing or being consulted on a patient: https://www.medscape.com/viewarticle/990494?form=fpf
https://youtu.be/GlfPSnHgC1A
https://www.jucm.com/supervising-doctors-may-be-held-liable-in-malpractice-suits/
https://www.medpagetoday.com/meetingcoverage/acep/106708
Increasing rates of malpractice and adverse reports for NPs:
https://youtu.be/EOeGhR2uUSU
PhysiciansForPatientProtection.org
On September 17, 2024, the Texas Senate Health and Human Services Committee held an interim hearing on scope of practice expansion for nurse practitioners and other clinicians. The Texas Medical Association (TMA) invited Rebekah Bernard, MD to testify regarding the economic impact of NP independence.
In part 1 of this series, we hear the NP expert witness, economist Alicia Plemons, followed by Dr. Bernard's testimony, along with questioning from the committee.
Learn more! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
Support our vision of physician-led care and truth and transparency for all medical practitioners: physiciansforpatientprotection.org
PhysiciansForPatientProtection.org
Christopher Garofolo, MD, unpacks the many errors shared by a more seasoned NP to a brand new NP seeking advice on a Facebook post.
Learn more: https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
PhysiciansForPatientProtection.org
On the last podcast, I interviewed Dr. Anu Shokla who shared her story of her newborn baby being treated for an emergency rapid response by a nurse practitioner who had just rotated with her on the inpatient adult hematology oncology service.
After hearing that podcast, Dr. Carol Nelson reached out to share a story of the alternate version: her newborn granddaughter was saved because of the outstanding care from well-trained physicians and non-physicians working together in a physician-led care team.
Please enjoy this inspiring and uplifting story of why physician training matters.
PhysiciansForPatientProtection.org
Primary care physician Anu Shukla shares a personal story about the dangers that patients face when physicians are replaced with nonphysician practitioners.
Dr. Shukla's comments on this podcast reflect her views and opinions. She does not speak for or represent her employer.
Physiciansforpatientprotection.org
patientsatrisk.com
PhysiciansForPatientProtection.org
In the first of a series 'The Nurse Will See You Now,' Bloomberg reporters investigate concerns about nurse practitioner education.
The Miseducation of America’s Nurse PractitionersThey don’t merely support doctors—NPs increasingly treat patients independently, including in specialty practices and emergency rooms. When they aren’t well trained, the results can be tragic. By Caleb Melby, Polly Mosendz, and Noah Buhayar
https://www.bloomberg.com/news/features/2024-07-24/is-the-nurse-practitioner-job-boom-putting-us-health-care-at-risk
Patients at Risk podcast episodes with nurses interviewed for the Bloomberg article:
Rayne Thoman, RN - Episodes 13, 14
John Canion, NP - Episodes 91-93
PhysiciansForPatientProtection.org
There are an estimated 500-750 clinics across the U.S. providing infusions of Ketamine for the treatment of a variety of medical conditions. This is big business, estimated to bring in $3.1 billion per year and projected to rise to 6.9 billion by 2030. But is Ketamine safe and effective?
Psychiatrist Kristina Kise, MD discusses the use of ketamine infusions in psychiatry, including the potential dangers to patients when physicians are not directly involved in drug oversight.
PhysiciansForPatientProtection.org
Psychiatrists are increasingly being replaced by non-physician practitioners - psychiatric mental health nurse practitioners (PMHNPs) and physician assistants (PAs). This webinar explains the difference between a psychiatrist and a PMHNP and reviews the evidence regarding unsupervised care of patients with mental illness by non-physicians.
Link to webinar video: https://youtu.be/djDos6xbRos
Contact me: PatientsAtRisk.com
PhysiciansForPatientProtection.org
Over the last decade, as physicians have increasingly turned to employed practice to cope with declining reimbursement and increased administrative requirements, our role in advocacy has diminished. Doctors are afraid to speak out because we fear being fired and losing our livelihoods. But without physician advocacy, corporate interests, academic centers, and government agencies are increasingly making decisions contrary to the best interests of patients, including replacing physicians with nonphysician practitioners. It is time for physicians to step up and take back control of healthcare decisions, and one of the best ways to do this is through self-ownership.
PhysiciansForPatientProtection.org
Arthur Smolensky, MD describes his experience creating a Small Democratic Group (SDG) to take over emergency department staffing from corporate contract management groups.
https://www.linkedin.com/in/arthur-smolensky-719806/
PhysiciansForPatientProtection.org
In today's episode, Teresa Camp-Rogers, MD, MS analyzes a study published in the Annals of Internal Medicine, the journal of the American College of Physicians, entitled
Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care Physicians
The article, which seems to call for an expansion of unsupervised practice for NPs, contends that NPs and physicians showed no differences in inappropriate prescribing to seniors based on Beers criteria, however, notes that NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing.
Dr. Camp-Rogers points out that since most NPs are practicing under physician supervision, with an estimated 2-6% of NPs practicing without physician supervision, this study may simply prove what other studies have established: the physician-led care model works - NOT that unsupervised practice is safe. Further, she argues that this study begs a follow-up question: with such variation in potentially inappropriate prescribing by NPs, what do we know about which NPs were in the top and which were in the bottom?
https://www.acpjournals.org/doi/10.7326/m23-0827
Get the books! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
PhysiciansForPatientProtection.org
Three years ago, we aired a podcast criticizing Doctors' Day posts from hospitals and healthcare organizations that included non-physicians and referred to physicians as 'providers.' Fast-forward to today, and some organizations (but not all!) seem to have gotten the message.
Happy Doctors' Day to all physicians - thank you for your sacrifice and dedication to patient care!
PhysiciansForPatientProtection.org
John Canion is an experienced nurse practitioner working within nursing for years to improve NP education. Frustrated with the lack of positive change from NP leadership, he penned the "2023 Report on Nurse Practitioner Education and the Need for Change," which outlines the current state of NP education and proposes solutions that harken back to the original days of NP training.
Canion suggests:
- At least 2 years of RN experience before starting NP school
- Increased standards for entry, including minimum GPA requirements
- Standardized, rigorous education and program-vetted preceptorship
- An increase to 2,000 hours of base NP training and an additional 4,000 hours of training within a specialty (Family, Psych, ER, etc).
He writes, "We need a pause on independent practice or 'full practice authority' for NPs until our education has been fully reviewed."
Read the entire report here:
https://jcthenp.substack.com/p/2023-report-on-np-education-and-the
PhysiciansForPatientProtection.org
PhysiciansForPatientProtection.org
John Canion is an experienced nurse practitioner working within nursing for years to improve NP education. Frustrated with the lack of positive change from NP leadership, he penned the "2023 Report on Nurse Practitioner Education and the Need for Change," which outlines the current state of NP education and proposes solutions that harken back to the original days of NP training.
Canion suggests:
- At least 2 years of RN experience before starting NP school
- Increased standards for entry, including minimum GPA requirements
- Standardized, rigorous education and program-vetted preceptorship
- An increase to 2,000 hours of base NP training and an additional 4,000 hours of training within a specialty (Family, Psych, ER, etc).
He writes, "We need a pause on independent practice or 'full practice authority' for NPs until our education has been fully reviewed."
Read the entire report here:
https://jcthenp.substack.com/p/2023-report-on-np-education-and-the
PhysiciansForPatientProtection.org
PhysiciansForPatientProtection.org
John Canion is an experienced nurse practitioner working within nursing for years to improve NP education. Frustrated with the lack of positive change from NP leadership, he penned the "2023 Report on Nurse Practitioner Education and the Need for Change," which outlines the current state of NP education and proposes solutions that harken back to the original days of NP training.
Canion suggests:
- At least 2 years of RN experience before starting NP school
- Increased standards for entry, including minimum GPA requirements
- Standardized, rigorous education and program-vetted preceptorship
- An increase to 2,000 hours of base NP training and an additional 4,000 hours of training within a specialty (Family, Psych, ER, etc).
He writes, "We need a pause on independent practice or 'full practice authority' for NPs until our education has been fully reviewed."
Read the entire report here:
https://jcthenp.substack.com/p/2023-report-on-np-education-and-the
PhysiciansForPatientProtection.org
In part 2 of my discussion of the Assistant Physician (AP) role, Dr. Keith Frederick meets Dr. Liz Troilo, who benefited from his legislation. After working as an AP, Dr. Troilo matched into residency and now provides critical access care as a Family physician in Missouri. Dr. Frederick proposes a possible alternate pathway to independent practice for physicians other than formal residency training.
Learn more about the importance of physician-led care - https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
PhysiciansForPatientProtection.org
Emergency physician Dr. Amish Shah has served the Arizona State House for the last five years and is now running for U.S. Congress. In this special bonus episode, Dr. Shah explains why he entered into politics, the work he has done to support the practice of medicine, and why physicians should donate to his campaign.
Learn more / contribute to Dr. Shah's campaign here: https://www.amishforarizona.com/
Meet Dr. Shah at his fundraiser at the Take Medicine Back meeting February 9, 2024 in Palm Springs https://www.takemedicineback.org/
PhysiciansForPatientProtection.org
There is no doubt that America is facing a physician shortage, due in large part to a lack of residency positions, the mandatory 1-3 years that medical school graduates must complete to receive a license to practice medicine. Today we are talking about a proposed solution to this problem—a new professional designation for unmatched medical school graduates called the “Assistant Physician” (AP).
I am joined by Dr. Keith Frederick, the originator of the first legislation to create the AP role, and Dr. Liz Troilo, who worked as an AP before becoming a board-certified family physician.
Learn more about physician-led care - get the book IMPOSTER DOCTORS.
PhysiciansForPatientProtection.org
In July 2023, 47 year old Jenifer Cleveland, a mother of four, died after receiving treatments at a Texas medispa. We reported on this tragic story in a podcast with plastic surgeon Alina Sholar (https://www.buzzsprout.com/1475923/13329411-when-wellness-turns-deadly-patient-dies-during-npp-medspa-visit.mp3?download=true).
Today, we are discussing the aftermath of this case and efforts by Texas physicians to ensure that no more patients die from ‘wellness’ treatments. Dr. Mary Kelly Green is an ophthalmologist and founding member of Texas 400, and advocacy group protection fighting to protect patients.
PatientsAtRisk.com
PhysiciansForPatientProtection.org
Malpractice insurance company CNA, along with Nurses Service Organization (NSO) has been providing malpractice coverage for nurse practitioners across the country in a variety of practice settings for the last 30 years. The organization released its first report on NP malpractice claims in 2005, and recently released its 5th report analyzing data between 2017 and 2022. Dr. Kevin Zhang joins me to discuss the findings of this report including:
- Increase in average total claims for NPs
- Highest average claim among NPs covered through an NP-office practice
- Most frequent claim: Failure to diagnose
https://www.nso.com/Learning/Artifacts/Claim-Reports/Nurse-Practitioner-Claim-Report-5th-Edition
Get the new book! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438
PhysiciansForPatientProtection.org
Nurse practitioner and Wisconsin Senator Rachael Cabral-Guevara jokes about 'missing' lobbyist Mark Grapentine's IV... and using the largest bore needle to try again. Bill co-sponsor Rep. Barbara Dittrich responds by pulling her name off the legislation.
Get the books!
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438
PhysiciansForPatientProtection.org
There has been a dramatic rise in the number of clinics offering intravenous infusions of fluids and vitamins to treat an array of conditions and for a supposed wellness benefit. But do these treatments actually work? To discuss the risks and benefits of IV infusions outside of a traditional medical setting I am joined by nephrologist Dr. Christin Giordano.
Get the new book! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438
PhysiciansForPatientProtection.org
Interventional cardiologist Dan Sraow, MD, FACC discusses the election of a nurse rather than a physician to lead the American College of Cardiology (ACC), as well as the risks of non-physicians performing cardiac interventions.
PhysiciansForPatientProtection.org
There is no doubt that America is facing a physician shortage, due in large part to a lack of residency positions, the mandatory 1-3 years that medical school graduates must complete to receive a license to practice medicine. To alleviate this shortage, some states have a new professional designation for unmatched medical school graduates called 'assistant physician' or 'graduate physician.'
Representatives for Louisiana Physicians for Patients discuss their role in passing legislation to allow graduate physicians the opportunity to work under the supervision of a licensed physician in the state.
PhysiciansForPatientProtection.org
Louisiana physicians discuss their successful effort to block scope of practice expansion in the state.
PhysiciansForPatientProtection.org
In 2023, three nurse practitioners sued the state of California for the right to call themselves 'doctors' in a clinical setting. Bioethicist Arthur L. Caplan, PhD, discusses the ethics of titles in healthcare.
Dr. Caplan's article - https://www.medscape.com/viewarticle/994536
Get the book Patients at Risk and Imposter Doctors!
PhysiciansForPatientProtection.org
At 39 years old, Hasina Hafiz wanted a physician to oversee her pregnancy and delivery. However, the only clinic in the area that accepted her insurance refused, allowing only CNM/ WHNP care. Retired OB/GYN John Lafferty, MD discusses complications that can occur during pregnancy and delivery, and why team-based care should always be led by a physician.
PhysiciansForPatientProtection.org
Jacqui O'Kane, DO was fulfilling the promise of Family Medicine, providing expert physician care to rural residents of Georgia. Burned out from overwork and support staff challenges, she decided to leave hospital employment. But instead of allowing her to open her own direct primary care practice, the hospital enforced a 50-mile radius noncompete contract, limiting patient access to care. Listen in on our discussion of noncompete contracts and why some physicians are leaving employed practice in favor of self-ownership.
For tips and tricks on surviving the fee-for-service world, check out my book, How To Be a Rock Star Doctor.
Docs, join our fight for physician-led care and truth and transparency among healthcare practitioners - Physicians for Patient Protection.
PhysiciansForPatientProtection.org
Sara O'Heron, MD discusses changes in the education and training of NPs and PAs over her 35-year career.
Learn more at PatientsAtRisk.com
Get the new book, Imposter Doctors, available in paperback, eBook and Audible: https://www.amazon.com/Imposter-Doctors-Patients-at-Risk-ebook/dp/B0C4J3P3Z1/
PhysiciansForPatientProtection.org
Plastic surgeon Alina Sholar, MD discusses the risks and dangers associated with non-physician supervised medspa medical procedures.
Get the new book! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
Join PPP: PhysiciansForPatientProtection.org
PhysiciansForPatientProtection.org
Employment attorney Dennis Hursh, Esq advises physicians on best practices for a fair employment contract.
Mr. Hursh is the owner of Physicians Agreements Health Law and the author of The Final Hurdle: A Physician's Guide to Negotiating a Fair Employment Agreement
https://www.amazon.com/Final-Hurdle-Physicians-Negotiating-Employment-ebook/dp/B07R596D28/
Contact him at https://pahealthlaw.com/
Get the new book, Imposter Doctors, a sequel to Patients at Risk. https://www.amazon.com/Imposter-Doctors-Patients-at-Risk-ebook/dp/B0C4J3P3Z1/
Effects of Non-physician Practitioners on Emergency Medicine Physician Resident Education
Permalink https://escholarship.org/uc/item/9g14r2jx
Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 24(3) ISSN 1936-900X Authors Phillips, Andrew W Sites, Jeremy P Quenzer, Faith C et al. Publication Date 2023 DOI 10.5811/westjem.58759
Andrew Phillips MD EdD is the author of
Survey Methods for Medical and Health Professions Education - E-Book: A Six-Step Approach
https://www.amazon.com/Survey-Methods-Medical-Professions-Education-ebook/dp/B092R848B9/
Hear details about the new book, Imposter Doctors: Patients at Risk, available NOW at Amazon and Barnes and Noble.
Can't find a job that doesn't require you to supervise non-physician practitioners? It's time to consider a return to self-ownership! Psychiatrist Dr. Rashida Gray discusses her journey and encourages physicians to take back control of medicine by opening their own practices. Learn more about Dr. Gray at her website: GrayMDPsychiatry.com
Join us: PhysiciansforPatientProtection.org
Emergency physician Andrew Wilson, MD, discusses a case in which a routine work physical at an Urgent Care resulted in an unnecessary ER visit for a patient.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Last week was Match week, and while thousands will celebrate matching into residency, 2,500 medical school grads will face an uncertain future due to a shortage of residency positions. If you know someone who might need help through this difficult time, the Physician Support Line is a free, confidential, and anonymous resource. Dr. Mona Masood, psychiatrist and founder of the Physician Support Line, discusses the importance of help for doctors.
Physician Support Line - 1 (888) 409-0141 https://www.physiciansupportline.com/
Psychiatrists helping our US physician and medical student colleagues navigate the many intersections of our personal and professional lives.
Free, Confidential & Anonymous
No appointment necessary
Call for any issue, not just a crisis
Nurse practitioner and physician assistant use are often justified because of a shortage of physicians, especially in underserved areas. One major cause of the physician shortage is a lack of residency positions, the required minimum training that must be completed after medical school to be licensed as a physician. Every year, thousands of aspiring physicians cannot complete that training because of a lack of funding for more residency positions.
While physician advocacy groups are lobbying Congress for more residency funding, some doctors are taking direct action to help medical school graduates to continue their journey toward becoming licensed physicians. Today we are joined by Mary Tipton MD, an internal medicine and pediatric physician, who has created opportunities for unmatched medical school graduates to gain additional training and experience at her medical clinic.
Contact Dr. Tipton at Mary.tipton@copperviewmedical.com
The COVID19 pandemic created both challenges and opportunities in the healthcare sector. One major winner: telehealth startup companies offering ‘virtual’ medical care, including psychiatric care. But instead of hiring physicians, these companies hire nurse practitioners to care for some of the most complex and vulnerable patients in our nation.
These companies got an even bigger boost when the U.S. Drug Enforcement Agency relaxed requirements for the prescribing of controlled substances due to the COVID19 pandemic. Online mental health companies quickly shifted gears to prescribing medications typically available only through a face-to-face visit, especially stimulant medications for attention deficit hyperactivity disorder (ADHD).
Today we are joined by psychiatrist Ziba Rezaee, MD to help us understand the rise of for-profit online mental health companies and the risks to patients.
Learn more: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Physicians, join us: physiciansforpatientprotection.org
Nurse practitioner and physician assistant advocates often assure physicians that they face little liability or risk when performing supervision, insisting that NPs and PAs are liable for their own errors. But case law examples demonstrate this to be false. If state law requires physician supervision or collaboration, the physician may be held vicariously liable in the event of negligence, even if they were not consulted by the nonphysician about the patient’s care.
Today we are talking with Nancy Berley MD and Shenary Cotter MD, family physicians who experienced negative repercussions when errors were made by associated nonphysicians.
Imagine this scenario: You are rolled into an operating room in a surgical center for an outpatient elective procedure. But when you wake up; you’re in an emergency department, and you learn that you nearly died from anesthesia complications. Even worse, you find out that your anesthesia was provided not by an anesthesiologist, but by a nurse anesthetist.
Paul Ambruster discusses his near-death experience after receiving anesthesia from a CRNA without anesthesiologist supervision. This is a cautionary tale for patients and physicians involved in the care of surgical patients.
Physicians train for at least 15,000 hours before we are permitted to practice independently, and one of the reasons is that it takes a long time and a lot of patient volume to be exposed to the many different presentations of disease processes to learn how to recognize true emergencies that need immediate interventions.
Today’s guest brings us a perfect example of the importance of this training. Karen Wilson Saintsing DVM is a veterinarian who nearly lost her arm after a nurse practitioner in an urgent care failed to recognize the onset of compartment syndrome. Fortunately, an astute emergency physician immediately recognized the condition and transferred her to a surgical center for treatment. To help us understand compartment syndrome, we are also joined by trauma surgeon Stephanie Markle DO MPH.
Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer.
Colorectal surgeon Amer Alame MD discusses the flaws in a study that claims to show that PAs can safely perform colonoscopies.
Fejleh MP, Shen C, Chen J, Bushong J, Dieckgraefe, B, Sayuk G. Quality metrics of screening colonoscopies performed by PAs. JAAPA. 2020;33(4):43-48.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer.
Colorectal surgeon Amer Alame MD discusses the flaws in a 2020 Johns Hopkins study advocating for the use of NPs to perform colonoscopies.
Riegert M, Nandwani M, Thul B, Chiu AC, Mathews SC, Khashab MA, Kalloo AN. Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients. Endosc Int Open. 2020 Oct;8(10):E1423-E1428. doi: 10.1055/a-1221-4546. Epub 2020 Sep 22. PMID: 33015346; PMCID: PMC7508647.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Tired of being owned by corporations, but don't want to open your own practice? Stephanie Freeman, MD, a critical care physician and entrepreneur, teaches physicians how to become self-employed through contract work and locums.
Learn more at DrStephanieICU.com
http://www.freelocumstraining.com for free online locums training.
National Association of Locums and Independent Physicians
http://www.na-lip.com
In Jan 2022, the Journal of Nursing Regulation published an article entitled:
Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency Departments
The summary: “Due to the variability in educational preparation, NPs should not perform independent unsupervised care in the ED regardless of state law or hospital regulations.”
This unequivocal statement contradicts the rhetoric of NP leadership which insists that NPs should be allowed to practice virtually anywhere and everywhere without supervision. Today I’m joined by family physician Christopher Garofalo, and radiologist and PPP board member Phil Shaffer to discuss this important paper.
Attorney and emergency medicine physician William P. Sullivan believes that nonphysician practitioners should practice independently, but be held to the same medical standard as physicians since NP/PA leaders argue that there is "no difference in the practices and outcomes between physicians and advanced practice providers."
Dr. Sullivan joins us to discuss his article on this issue - https://sullivanlegal.us/nurse-practitioner-and-physician-assistant-standard-of-care/
Get the book! https://www.amazon.com/dp/B08M9YJQR3/
In several previous podcasts, you have heard us refer to research studies that claim to show that nurse practitioner care is just as good or better than that provided by physicians. We’ve shown that in many of these cases, the study authors are using flawed methodology or failing to disclose important information, like nurse practitioners working under physician supervision.
Today we invite you to attend Patients at Risk’s first “Journal Club” session as we dissect a study that claims to show that having more nurse practitioners working in hospitals improves patient care, and the methodology used by the authors is just about one of the most egregious examples we have ever seen. To help explain this study, we are joined by two physician experts, Dr. Dylan Golomb and Dr. Marsha Haley.
THE BOTTOM LINE: The study authors claim that “having more NPs in hospitals has favorable effects...and adds value to labor resources” - but the methodology they use involves asking nurses to ESTIMATE the number of NPs that work in their hospitals - without any validation that this estimate is accurate.
Aiken LH, Sloane DM, Brom HM, Todd BA, Barnes H, Cimiotti JP, Cunningham RS, McHugh MD. Value of Nurse Practitioner Inpatient Hospital Staffing. Med Care. 2021 Oct 1;59(10):857-863. doi: 10.1097/MLR.0000000000001628. PMID: 34432769; PMCID: PMC8446318.
GET THE BOOK: https://www.amazon.com/dp/B08M9YJQR3/
Douglas Farrago MD discusses why '9 out of 10 administrators' absolutely hate his new book, The Hospital Guide to Physician Retention: Why Creating A Physician-Friendly Environment Is Critical For Your Organization’s Success.
Dr. Farrago has been fighting to improve the state of medicine for decades, authoring books on direct care and pointing out the fallacies in health care at his blog, AuthenticMedicine.com. His newest book, The Hospital Guide to Physician Retention is focused on improving the work environment of physicians.
"When doctors feel valued and have meaningful relationships with their patients and co-workers, they are much less likely to leave," says Farrago, which saves hospitals up to $1 million per physician. "Happy doctors stay, and happy doctors help recruit other doctors, leading to happier and more satisfied patients."
So, why did so many administrators hate this book?
Sonal Patel MD and Jou Jou Hanna MD discuss the difficult choices that women make to become physicians, and why that training matters.
One topic that gets women physicians fired up like no other is a discussion of gender issues in medicine. While medical school classes are currently made up of about 50% women, women physicians are still a significant minority in medical practice today, and women doctors face serious inequities due to their gender. One of the biggest challenges that women must face is the decision of if or when to have children, because of the intense and lengthy educational training process that doctors must complete.
A recent post from a nurse practitioner student who reported feeling guilty about being away from her children while on clinical rotations caused controversy among women physicians. Many women physicians noted that the number of clinical hours that the nurse practitioner student was complaining about was just a fraction of what they have had to go through while other women physicians argued that no woman clinician should have to feel guilt about balancing child-raising with education. Dr. Sonal Patel and Dr JouJou Hanna join us to discuss the nuances of this issue.
Part 2 of our discussion with John Lafferty MD regarding the need for Flexner-style reform for NP and PA programs. Dr. Lafferty describes his experiences training PA students.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Thanks to our sponsor:
Old Pueblo Anesthesia (OPA) is a physician-owned and operated practice that has served the southern Arizona community for over 40 years. They are committed to delivering anesthetic care exclusively by physicians and annually provide over 20,000 anesthetics to patients undergoing surgery, labor and delivery, pain management, and diagnostic procedures. OPA provides anesthetic services at multiple outpatient surgery centers and is the exclusive provider of anesthesia services at TMC Healthcare, a large regional health care system in Tucson, Arizona.
Their cardiac anesthesiologists cover a robust open-heart program and are also intimately involved in the operation of the largest minimally invasive structural heart program in Southern Arizona.
TMC has a level III NICU and OPA’s Labor and Delivery team provides 24/7 in-house coverage for over 5000 deliveries per year.
Outside the operating room, they provide anesthesia services for adults and children in the GI suite, MRI/CT, and interventional radiology.
OPA’s leadership and recruiting team would love to discuss professional employment opportunities for anesthesiologists with the desire to live and work in a part of the country with incredible weather, year-round outdoor activities and a very affordable cost of living.
They currently have openings for both partnership track positions as well as several employee/non call positions. OPA is seeking pediatric fellowship-trained anesthesiologists, cardiac fellowship-trained anesthesiologists and has positions available for non-fellowship trained anesthesiologists as well. There are positions available with no hearts or OB if you do not want to work in those areas.
For more information, please contact Mark McClain, M.D., @ Mark.McClain@opatucson.com or Jim Rodriguez, CEO @ jrodriguez@opatucson.com or visit their website at www.opatucson.com
Many of our podcasts have focused on concerns about the deterioration of nurse practitioner training, with an increase in for-profit schools that compete fiercely for student tuition dollars. These programs often boast 100% acceptance rates -in other words, anyone who applies is accepted. Students who attend programs like these complain about sub-par education including open-book tests that leave graduates inadequately prepared to care for patients.
The rise of these diploma mills has led many to call for reforms to the NP educational process. What many people do not realize is that the medical profession also faced serious reforms in its educational process following the release of the Flexner report which outlined problems in the training of physicians back in 1910. Today I am joined by Dr. John Lafferty to discuss the Flexner report and the importance of standardizing education for medical professionals. Dr. Lafferty is an obstetrician-gynecologist with a special interest in the history of medical education.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
We highly recommend Physician Outlook magazine - a magazine for physicians and patients, created by physicians. Learn more at PhysicianOutlook.com
One of the strategic goals of the American Association of Nurse Practitioners listed on their website (now behind a paywall) is for nurse practitioners to achieve pay parity: to be paid the same as physicians. Oregon became the first state to require that insurance companies pay nurse practitioners the same as physicians and now proposed legislation would do the same in Washington state. To discuss the implications of pay parity in Washington and elsewhere, we are also joined by the past president of the Washington state radiological society, Dr. Pooja Voria.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
As nonphysician practitioners increasingly provide more patient care, experts note a commensurate increase in medical malpractice claims. Today we welcome medicolegal adviser Bob Pegritz, the co-author of ‘Hospital Confidential,’ an expose of medical malpractice cases. As Bob wrote me, "I have worked in the medical/legal community for 32 years. Before that, I was a surgical PA. As a medical/legal consultant, I have seen a trend over the past 5 years of more PAs crossing my desk for merit review in potential medical malpractice cases. And I think that the number of mid-level healthcare practitioners will do nothing but increase if things don't change."
Get Bob's book! https://www.amazon.com/Hospital-Confidential-Bob-Pegritz/dp/B09LGTSXFV/
For more information, visit PatientsatRisk.com
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
As our listeners already know by now, to be licensed to practice medicine, physicians in most states must complete a minimum of three years of postgraduate medical education, called residency training. Each specialty offers its own residency program, but all must follow specific, standardized criteria created by the ACGME—the American College of Graduate Medical Education. If programs fail to meet these criteria, they will not be credentialed by the ACGME, and graduates will not be licensed to practice medicine.
Recently, the ACGME announced revisions to residency training for Family Physicians, and I’m privileged to be joined today by two family physicians to discuss the proposed changes. Dr. Mark Huntington is the director of the Center for Family Medicine at the South Dakota Sanford School of Medicine, and Dr. Rishi Patel is a family physician and a relatively recent graduate of residency training.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Almost every field of medicine today involves some type of nonphysician practitioner, whose role was originally created to help physicians see patients more efficiently. The specialty of radiology is no exception, and radiologists often work with NPs, PAs, and another type of extender called a radiology assistant (RA). In part 2, I am joined by two radiologists to discuss the use of nonphysicians in radiology and concerns that an increased push for these extenders may negatively impact patient care.
Phil Shaffer MD is a recently retired radiologist and frequent guest of our show. He is also a board member of PPP. Sharon D’Souza MD MPH is a radiologist in private practice.
Almost every field of medicine today involves some type of nonphysician practitioner, whose role was originally created to help physicians see patients more efficiently. The specialty of radiology is no exception, and radiologists often work with NPs, PAs, and another type of extender called a radiology assistant (RA). Today I am joined by two radiologists to discuss the use of nonphysicians in radiology and concerns that an increased push for these extenders may negatively impact patient care.
Phil Shaffer MD is a recently retired radiologist and frequent guest of our show. He is also a board member of PPP. Sharon D’Souza MD MPH is a radiologist in private practice.
A few months ago, EM:RAP, a well-known and respected EM CME provider hosted a discussion about nonphysician practitioners in the emergency room. Many physicians who listened felt was one-sided and glossed over concerns about independent practice by NPs and PAs. Dr. Steve Carroll, an EM physician and the host of the podcast EM Basics, was so concerned that he reached out to the program to ask for a more even discussion. To their credit, the program allowed him come on to discuss some of the nuances that the initial episode missed. Today we will discuss the initial EM RAP episode that caused so much controversy and Dr Carroll’s response.
Catch Dr. Carroll at his website http://embasic.org/
Get the book Patients at Risk: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
In part 2 of our discussion, Dr. Alyson Maloy and Dr. Phil Shaffer break down the mistruths in AANP president April Kapu's article, 'Full practice authority for nurse practitioners needed to address physician shortage.'
Get the book, now available on Audible! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Watch the video on our YouTube channel: https://youtu.be/EDXn7RAomTM
Article links:
Original article - https://www.medicaleconomics.com/view/covid-exacerbates-physician-shortage
AANP rebuttal - https://www.medicaleconomics.com/view/response-full-practice-authority-for-nurse-practitioners-needed-to-address-shortage
PPP response - https://www.medicaleconomics.com/view/rebuttal-congress-not-the-aanp-can-resolve-the-physician-shortage
On September 29, 2021, the journal Medical Economics published an interview with Dr. Alyson Maloy entitled “Covid exacerbates physician shortage.” In the article, Dr. Maloy discussed the effects of covid19 including a push to increase practice authority for nurse practitioners. A week later, Medical Economics posted a rebuttal written by April Kapu, the president of the AANP, called “Full practice authority for nurse practitioners needed to address physician shortage,” arguing that NPs were ready and willing to fill the physician gap. Because the article included many mistruths, Dr Maloy and her colleague Dr Phil Shaffer, board members of Physicians for Patient Protection (PPP) wrote a rebuttal to the rebuttal, pointing out all the flaws in Kapu’s argument.
In part 1, we discuss Kapu's accusations that PPP is a 'fringe' organization out to destroy team-based care, and explain why she and the AANP are dead wrong.
Get the book, now available on Audible! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Watch the video on our YouTube channel: https://youtu.be/EDXn7RAomTM
Article links:
Original article - https://www.medicaleconomics.com/view/covid-exacerbates-physician-shortage
AANP rebuttal - https://www.medicaleconomics.com/view/response-full-practice-authority-for-nurse-practitioners-needed-to-address-shortage
PPP response - https://www.medicaleconomics.com/view/rebuttal-congress-not-the-aanp-can-resolve-the-physician-shortage
In part 2 of this discussion with plaintiff's attorney Travis Dunn, we analyze the tragic case of Alexus Ochoa, who died because a multi-billion dollar corporation elected to replace physician with unprepared NPs. Mr. Dunn discusses the role of the expert witness in NP malpractice cases and what he has learned about the limited scope of practice of nurse practitioners.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Please like and subscribe to our channel Patients at Risk: https://www.youtube.com/channel/UCLLDpz_f6u7EuW-BKnar-AA
In the book Patients at Risk, we discuss the tragic case of Alexus Ochoa, a 19-year-old woman who died when a nurse practitioner failed to diagnose the blood clot in her lungs. The nurse practitioner was unprepared to treat emergency room patients and there was no physician on-site, even though the hospital advertised that physicians were available 24/7. Today we are joined with attorney Travis Dunn, one of the lead attorneys who helped Alexus’s family win a major financial settlement against Mercy Health Systems for replacing physicians with nurse practitioners.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Watch the video on our YouTube channel, Patients at Risk: https://www.youtube.com/channel/UCLLDpz_f6u7EuW-BKnar-AA
There are so many challenges in healthcare today, and it’s becoming ever more difficult to practice medicine. In fact, many physicians that could continue to work well into their golden years are retiring as soon as they can because the struggle of practicing medicine is just no longer worth it to them.
Today we are joined by an amazing physician who has experienced his share of heartache within our healthcare system. Dr. Mark Lopatin is a rheumatologist who has written extensively about his experiences, and he joins to share his insights and thoughts about how we can improve our broken healthcare system.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Dr. Lopatin's writing:
"I knew she was trouble" - https://judiciary.pasenategop.com/wp-content/uploads/sites/42/2020/09/Article-Mark-Lopatin-MD.pdf
"The facts did not matter" = https://mail.google.com/mail/u/0/#search/mlopatin%40comcast.net/FMfcgzGljvNMgRKMzxvTnTCJSXrMsxnD?projector=1&messagePartId=0.1
"This physician is retiring: here is his most valuable lesson" =
https://www.kevinmd.com/blog/2020/12/this-physician-is-retiring-heres-his-most-valuable-lesson.html
Today, we discuss a topic that is near and dear to my heart as a family physician: the role of primary care. We’re going to focus especially on the misconception often held by legislators that primary care is somehow ‘easy,’ and can therefore be relegated to allied health professionals, especially nurse practitioners.
Today, I am joined by two special guests who are experts in the role of primary care in the healthcare system. Dr. Emily O’Rourke is a Family Physician in Virginia and the owner of Fountain Direct Primary Care. (https://fountaindirectprimarycare.com)
We are also joined by Dr. Meghan Galer, a board-certified emergency physician who opened her own direct primary care practice, ColGACare, in Georgia. (https://www.colgacare.com)
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
References:
BMJ 2018 - Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality https://bmjopen.bmj.com/content/8/6/e021161
BMJ 2019 - US patients live longer in areas with more primary care doctors, study finds BMJ 2019; 364doi: https://doi.org/10.1136/bmj.l804(Published 20 February 2019) BMJ 2019;364:l804
Mortality rates are lower with higher continuity of care, review finds BMJ 2020;370:m3184
Lancet: http://dx.doi.org/10.1136/bmjgh-2017-000424
Gray BM, Vandergrift JL, McCoy RG, et al Association between primary care physician diagnostic knowledge and death, hospitalisation and emergency department visits following an outpatient visit at risk for diagnostic error: a retrospective cohort study using medicare claims BMJ Open 2021;11:e041817. doi: 10.1136/bmjopen-2020-041817 http://dx.doi.org/10.1136/bmjopen-2020-041817
In our book, we outline the tragic case of Alexus Ochoa, a 19-year-old woman who died when a nurse practitioner failed to properly diagnose and treat the blood clot in her lungs. The only reason that the details of this case became public was because of a lawsuit filed by the patient’s family. Court records reveal not only a lack of appropriate medical care, but more importantly, the incredible efforts that Mercy Health Systems, a multi-billion-dollar corporation, routinely went through to hire and credential nurse practitioners to work in positions completely outside of their scope of practice, putting patients at risk to save money and increase profits.
Today we talk with attorney Robert Painter about the role of the legal system in holding bad actors like this accountable. Mr. Painter is a former hospital administrator who is now a medical malpractice and wrongful death lawyer at Painter Law Firm in Houston, Texas.
https://painterfirm.com/
Get the book! Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
One of the biggest challenges in healthcare today is a lack of transparency when it comes to the training and licensure of healthcare professionals. As members of the healthcare team have taken an increased role in providing medical care, patients may be treated by physicians, nurse practitioners, physician assistants, and other healthcare practitioners, and understanding who is who can be difficult. In fact, an AMA study found that only 55% of respondents thought it was easy to identify who is a licensed physician. Moreover, 79% of respondents said that they would support legislation to require that patients be informed of the level of education, skills, and training of all health care professionals.
Fortunately, some states are taking action to ensure truth and transparency among healthcare practitioners, with New Jersey leading the way. Today we are joined by two special guests to discuss the New Jersey Health Care Transparency Act, which was passed in 2020: Marlene Kalayilparampil, MHA, FHELA is the manager of government relations for the Medical Society of New Jersey, and Dr. Flowers is a practicing physician in New Jersey.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/premium/arc/tia-survey_0.pdf
There is an increasing double standard in the practice of medicine and the practice of advanced nursing, and one of these is the difference in ‘board certification.’ Nurse practitioners take just one board examination in the course of their career, which is 3 hours long and 200 questions. Nurse practitioners never have to take another exam – they just have to submit their work hours, which can even be volunteer hours.
In contrast, physician board exams are most more rigorous, lasting 9-10 hours or more, and must be repeated every 7-10 years. In 2015 the American Board of Medical Specialties added another layer to the process, requiring that physicians participate in a continuous “Maintenance of Certification” (or MOC) process to maintain board certification.
Many physicians balked at the increased burden and cost of this MOC process, and grassroots organizations even sprung up to provide alternate pathways to make it easier for physicians to practice medicine. Today we are talking with Dr. Paul Mathew, a neurologist and a board member of the National Board of Physicians and Surgeons.
Get the book 'Patients at Risk:" https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Join PPP: https://physiciansforpatientprotection.org
Certify with the National Board of Physicians and Surgeons: https://nbpas.org
Seven-year-old Betty died just 15 hours after she was evaluated by a pediatric nurse practitioner in a pediatric urgent care without any physician on site. Betty's father, Jeremy Wattenbarger discusses the efforts he has made to seek accountability and ensure that other children receive physician-led care.
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Many of our critics accuse us of exaggerating the risks that patients face when physicians are replaced by lesser trained members of the healthcare team. We are often told that we are engaging in a ‘turf war’ with nurse practitioners and physician assistants and that we should support these nonphysicians practicing ‘to the full extent of their license and training. ’ Today we are going to explain exactly why we take such a hardline stance against the independent practice by nonphysicians. It’s not because of a turf war - it’s because of patients like seven-year of Betty Wattenbarger, who died after a pediatric nurse practitioner failed to diagnose her with pneumonia and sepsis, an overwhelming blood infection. Betty’s father, Jeremy, is on a crusade to ensure that other parents do not lose their children because of a lack of access to care by a properly trained physician.
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
In part 2 of our discussion about healthcare politics, Dr. Kermit Jones, a California internal medicine physician, attorney, and military veteran discusses his run for California's 4th Congressional District.
Learn more about Dr. Jones at his website - https://kermitjonesmdjd.com/
Donate to Dr. Jones' political campaign here - https://secure.actblue.com/donate/kermitjonesforcongress2
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Physicians: Join us at htpps://Physiciansfor PatientProtection.org.
More than ever, healthcare and politics are intertwined. Decisions made by politicians and have a major impact on not only healthcare policy, but on the day-to-day practice of medicine by physicians. Today we are excited to be talking about healthcare politics with Dr. Kermit Jones, a California internal medicine physician, attorney, and military veteran who is working to bring his medical expertise into the political arena.
Learn more about Dr. Jones at his website - https://kermitjonesmdjd.com/
Donate to Dr. Jones' political campaign here - https://secure.actblue.com/donate/kermitjonesforcongress2
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Physicians: Join Physicians for Patient Protection - https://physiciansforpatientprotection.org
In part 2 of this discussion with Dr. Marion Mass, a pediatrician and the co-founder of Practicing Physicians of America, we learn about the impact of group purchasing organizations (GPOs) on the high cost of healthcare. In 1987, the federal legislature granted GPOs safe harbor from anti-kickback statutes, allowing them to reap millions of dollars. Dr Mass also explains how these GPOs have created artificial shortages in essential medical supplies, leading to patient and clinician harm.
Practicing Physicians of America: https://practicingphysician.org/
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
We all know that the health care system in the United States is expensive, with the U.S. spending more than any other developed nation. Although it’s convenient to scapegoat doctors as the reason for high medical costs, the truth is that physician compensation makes up just 20% of total health spending. So, who is really responsible for the astronomical cost of health care today? To get some answers, we are joined by Dr. Marion Mass, a pediatrician and the co-founder of Practicing Physicians of America.
In part 1 of this series, Dr. Mass explains how Pharmacy Benefit Managers (PBMs) have benefited from safe harbor from anti-kickback statues, allowing them to reap millions of dollars and increasing drug costs for Americans.
Practicing Physicians of America: https://practicingphysician.org/
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
On our last podcast, advocacy experts Dr. Purvi Parikh and Linda Lambert discussed steps that physicians can take to advocate for their patients and for the profession of medicine. In part 2, we learn from the legislative successes of the nursing profession. We discuss how to write a resolution for your medical society to help influence policy, and how advocacy can be a solution to burnout.
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Physicians are usually so busy taking care of patients that we sometimes ignore the political aspects of healthcare, leaving the decisions to legislators and policymakers, many of whom do not truly understand what it is like to deliver medical trenches in the trenches. Unfortunately, the old adage, “if you’re not at the table, you’re on the table,” is nowhere truer than in the healthcare legislative process.
Today, I am joined by two experts to help us understand how physicians can be effectively involved in advocacy for our patients and for our profession.
Dr. Purvi Parikh is an allergist and immunologist practicing in New York who has been involved in political advocacy since she was a medical student. She is also a fellow board member of Physicians for Patient Protection.
Linda Lambert served as the executive director for the New York chapter of the American College of Physicians for over 20 years and has spent the last several years of her pseudo-retirement helping Physicians for Patient Protection build our organization.
When it comes to discussing the differences between physician assistants (PAs) and physicians, there is no one better to address the issues than someone who has trained and worked in both professions. Christin Giordano MD was a PA before deciding to return to medical school to become a physician. She has since completed residency training and a fellowship to become a nephrologist. We are also joined by Elizabeth Ennis, PA-C, a former classmate of Dr. Giordano, who is currently practicing in California. Together, we discuss the state of the PA profession, including the proposed name change from 'physician assistant' to 'physician associate' and independent practice for PAs.
Read Dr Giordano's KevinMD post: From PA to MD: An appreciation for physician education
Get the book Patients at Risk!
One of the biggest issues in medicine today is physician burnout, with almost 50% of all physicians reporting making active plans to leave the practice of medicine. We are joined by an expert on the subject of physician wellness, psychiatrist Wendy Dean. Dr. Dean and her co-author have singlehandedly changed the dialogue away from ‘burnout’ and towards the concept of ‘moral injury.’ We asked Dr. Dean for her perspective on the impact of corporatization and the replacement of physicians by nonphysician practitioners on physician morale and burnout.
Dr. Dean's landmark article: https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/
And Dr. Dean's article on her experience with the healthcare system:
https://www.wbur.org/commonhealth/2020/01/24/moral-injury-american-medicine
Dr Dean's website and podcast:
https://fixmoralinjury.org/
https://podcasts.apple.com/us/podcast/moral-matters/id1529907905
Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
We are joined by Eric Starkman, an investigative journalist who works to shed light on dangerous corporate practices in healthcare. Mr. Starkman is relentless in exposing the work of bad actors in the medical-industrial complex and discusses how the replacement of physicians by nonphysician practitioners is contributing to the decline of the U.S. healthcare system.
Read Eric Starkman's article about the book 'Patients at Risk' here.
An excerpt: "The deceit are the studies purportedly showing that NP and PA patient outcomes are statistically the same as medical doctors. According to Niran Al-Agba and Rebekah Bernard, the MD authors of “Patients at Risk,” all of the studies involved NPs and PAs who worked under the supervision of doctors. The authors insist there are no credible studies evaluating patient outcomes involving NPs and PAs working without medical supervision, which they are doing with increasing frequency.
The corruption is that hospitals and other healthcare facilities are increasingly foisting NPs and PAs on patients without patients knowing it. The trend in healthcare today is to refer to everyone who interacts with patients as “healthcare providers” and they all wear white coats. At some hospitals, even the orderlies and housekeeping staff wear white coats, so it’s impossible to distinguish the real doctors among the white coat brigades.
Nurse practitioners and physician assistants aren’t real doctors. They can’t, don’t, and never will provide comparable medical care. They’re MD Lites – Less training. Less knowledge. Less skills."
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About 42% of physicians report feeling burned out, and about half of all doctors are making active plans to leave the practice of medicine. Unfortunately, some doctors turn to drugs and alcohol to cope with the stressors of medicine, which may result in the loss of their professional licenses. Today, we are talking with Dr. Daniel Hochman, a psychiatrist, and an online professional recovery program creator to discuss physician well-being.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Dr. Daniel Hochman's online recovery program: https://www.selfrecovery.org/about-dr-hochman/
Physician support line: 1 (888) 409-0141
https://www.physiciansupportline.com/
"Psychiatrists helping our US physician colleagues and medical students navigate the many intersections of our personal and professional lives" - free and confidential
On May 24, 2021, JAMA, or the Journal of the American Medical Association, published a viewpoint entitled: “Advanced Practice Clinicians—Neurology’s Underused Resource.” The article was authored by nurse practitioner Calli Cook and Dr Heidi Schwarz, a neurologist with the University of Rochester and argued that due to a shortage of neurologists across the country, non-physician practitioners should be used more widely to provide neurology care to patients.
Physicians for Patient Protection submitted a letter to the editor expressing concerns about these viewpoints, however, JAMA Neurology declined to print our letter, citing space concerns and "your letter did not receive a high enough priority rating for publication."
Neurologist/ psychiatrist Dr. Alyson Maloy and neurologist Dr. Carol Nelson join me to discuss the replacement of neurologists by nonphysician practitioners.
Link to JAMA Neurology article: https://jamanetwork.com/journals/jamaneurology/article-abstract/2780419
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Join physiciansforpatientprotection.org
One of the ways that corporations have been successful in replacing physicians with lesser-trained medical practitioners is by creating a sense of equivalence so that patients think that the care they will receive is “the same.” For example, both physicians and nurse practitioners and physician assistants wear white coats, have similar-appearing badges, and may be referred to as “doctor” even if that doctorate is not a medical degree.
Not only do these corporations elevate the role of nonphysicians, they also work to bring down the level of physicians. On many health system websites, physicians are listed as mere “providers.” The once-named “doctor’s lounge” is now the provider’s lounge. And now, some institutions have even taken aim at “Doctor’s Day,” hijacking the one day devoted to showing appreciation for physicians and turning the focus instead on the healthcare ‘team’.
Today, Dr. Marsha Haley, a radiation oncologist, joins us to discuss an article that she wrote for the Buck’s County Courier Times about the appropriation of ‘Doctor’s Day’.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Dr. Haley's article: https://www.goerie.com/story/opinion/2021/04/18/op-ed-doctors-shouldnt-have-share-their-day-especially-year/7219700002/
Vanity Fair article discussing group purchasing organizations (GPOs) and their contribution to a shortage of PPE - includes details that Kevin W. Sowers, RN, MSN, the president of Johns Hopkins Health System, was a board member of a GPO that began servicing the hospital system after Sowers became the system's leader.
https://www.vanityfair.com/news/2020/05/corporate-deals-making-hospitals-ppe-shortages-worse May 2020
One of the differences between physicians and nurse practitioners is that physicians are regulated by a state Board of Medicine, while in most states, nurse practitioners are regulated by a state Board of Nursing. This distinction is important, because while nurse practitioners are functioning in the same capacity as physicians—ordering and interpreting tests, making medical diagnoses, and writing prescriptions for medications—they are overseen by a regulatory body that includes nurses without experience in this type of practice, which can result in a lack of appropriate action when a nurse practitioner is practicing improperly.
Today we are going to discuss the case of nurse practitioner Jeffrey Young, the so-called, “Rock Doc,” who was indicted in 2019 for prescribing controlled substances to his patients “to obtain money, notoriety, and sexual favors.” Despite multiple reports to the Tennessee board of nursing, outside agencies took five years and action before Young finally lost his prescribing privileges. Emergency medicine physician Dr. Teresa Camp-Rogers joins us to discuss the details of this case.
Atlantic article: https://www.theatlantic.com/health/archive/2021/01/rock-doc-opioids/617405/
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
In our book, we dedicate several chapters to discussing the differences in training between physicians and non-physician practitioners. One of the most important elements of physician training is learning how to create a differential diagnosis, which is a list of all the possible causes of a patient’s symptoms. Today we are joined by Dr. Mercy Hylton, a pediatric emergency medicine physician and who is also an author and a patient advocate, to discuss why physician training - including learning how to properly create a differential diagnosis - is so important.
Get the book - now available as an audiobook from Audible and at iTunes:
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/B08Z4F1JJ6/
Physicians: Join us! Physiciansforpatientprotection.org
Dr. Hylton's articles:
An Ode to the Differential Diagnosis - https://www.kevinmd.com/blog/2021/03/an-ode-to-the-differential-diagnosis.html
Find more blogs by Dr. Hylton at: https://www.kevinmd.com/blog/post-author/mercy-hylton
In part 2 of this discussion with emergency physicians Dr. Robert McNamara and Dr. Mitch Li, we learn about the dangers that patients face due to the takeover of private equity in healthcare.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
When you are taken by ambulance to the nearest emergency department, you are completely vulnerable. This is not the time when you can research or negotiate prices. With the corporate takeover of hospitals, bills for emergency services have skyrocketed. Patients often receive enormous bills that can sometimes even bankrupt them. These corporate systems are also taking advantage of physicians, and in many cases, replacing them with non-physician practitioners.
We are joined by two experts on the subject – Dr Robert McNamara is an emergency room physician who has been publishing articles on this subject for 25 years. Dr Mitch Li is an emergency medicine physician with a practice based on the direct primary care movement and is raising awareness about the dangers of private equity and corporate healthcare.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Articles by Dr. McNamara:
Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future - https://www.jem-journal.com/article/S0736-4679(16)00007-X/fulltext
A Survey of Emergency Physicians Regarding Due Process, Financial Pressures, and the Ability to Advocate for Patients - https://www.jem-journal.com/article/S0736-4679(12)01725-8/fulltext
More reading:
The Rape of Emergency Medicine - Free download at https://www.aaemrsa.org/get-involved/the-rape-of-em
In recent years, there has been a massive increase in medical practitioners offering hormone therapy to patients. Since insurance doesn’t cover these treatments other than for very specific medical conditions, most patients end up paying cash, leading to big profits. These treatments are usually promoted as “wellness” products, intended to make patients feel younger, stronger, thinner, and just all-around better. But the truth is that there is no clear evidence hormones cause these benefits, and when used improperly, hormone therapy can cause serious risks to patient health, and even cause death.
Today we are joined by Dr. Joyce Varughese, a gynecologist oncologist. As a doctor treating women with gynecologic cancers, she has seen serious harm caused by patients from using unapproved therapies and is here to share important safety information for patients. Dr. Varughese, welcome to the show!
Get the book!
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Hospital organizations are increasingly replacing physicians with nurse practitioners and physician assistants who act as "hospitalists." John Chamberlain, the board chairman of Citizen Health and a former hospital CEO, discusses his wife's hospital stay, during which her care was supervised by a nurse practitioner.
We also discuss the increasing corportization of health care and the importance in transparency among health care practitioners and hospital pricing.
Citizen Health aims to redesign healthcare by putting patients and physicians in control. Learn more at https://citizenhealth.io/.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
In December, Patients at Risk aired two podcasts in which we discussed the case of Gerald “Jay” Baltz, a psychiatric nurse practitioner who was under investigation by the California board of nursing for engaging in an inappropriate sexual relationship and providing questionable treatment to a patient who subsequently took her own life.
While we did not provide any identifying details at that time other than what was included in public documents, since the time of that recording, friends and family members have come forward to identify the patient as Stevie Ryan, a Hollywood comedienne and YouTube sensation who seemed to be on the verge of stardom when her life came to a tragic end at the age of just 33 years old.
We are joined today by Yuni Kim, Stevie Ryan’s close friend and confidant, to discuss mental health issues and care provided by different types of mental health clinicians. Yuni previously shared this information with the LA Times as discussed in this article: https://www.latimes.com/business/story/2021-04-01/stevie-ryan-death-nurse-practitioner
If you are having concerns about mental health, help is available. Please call the suicide prevention lifeline at 800-273-8255.
Links to previous discussions of this case:
https://podcasts.apple.com/us/podcast/psych-np-patient-affair-ends-tragically-case-jay-baltz/id1539719940?i=1000503087095
https://podcasts.apple.com/us/podcast/differences-between-psychiatrists-psych-nps-case-jay/id1539719940?i=1000503719243
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Learn more: PatientsatRisk.com
Physicians: Join Physicians for Patient Protection: www.pppofficialsupporter.com
In our book, we discuss the case of Alexus Ochoa, a healthy 19 yr old woman who died when a nurse practitioner failed to properly diagnose her. What is particularly worrisome about this case is that when Alexus was taken to the emergency room by ambulance, the only medical practitioner working there was a nurse practitioner. Unfortunately, this situation is occurring in hospitals across the country. Physicians are being replaced by non-physician practitioners, and patients often have no idea.
Today we are joined by two emergency physicians who have become aware of this trend and are publicly speaking out about their concerns, Dr. Thomas Cook and Dr. Jason Adler.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Articles by Drs. Adler and Cook
https://journals.lww.com/em-news/Fulltext/2021/02000/After_the_Match__Boosting_Profits_Drives_NP.6.aspx
https://journals.lww.com/em-news/Fulltext/2021/03000/After_the_Match__NPs_Pushing_Expansion_of.2.aspx?context=FeaturedArticles&collectionId=3
Nearly half the states in the Union have legislated the unsupervised practice of medicine by nurse practitioners and currently, one state allows physician assistants to practice without physician supervision. This legislative season we are seeing bills to allow independent practice for nurse practitioners and physician assistants in multiple states that do not currently allow the practice. Today we are joined by two Texas physicians who are working to educate patients and legislators about the importance of physician-led care.
Cathy McLaughlin MD is a urologist practicing in Texas and Saba Rizvi MD is a Texas emergency physician who authored a paper on the Private equity takeover of EM groups and their push for more NP staffing models.
In our previous podcasts, we have focused on the differences in scope of practice between physicians and nurse practitioners. But other medical practitioners are also wading into the diagnosis and treatment of conditions that have previously been the domain of physicians. Today we are going to discuss care provided by chiropractors, specifically when chiropractors step outside of their traditional role in providing spinal adjustments and into medical treatment for neurological conditions.
To help us understand this topic, we are joined today by two special guests, patient Nancy Murphy and her neurologist Dr. Dhrupad Joshi.
Dr Joshi's website: https://wecareneuro.com/
After the brain, the human eye is the most complicated organ in the body. It is for this reason that a graduating doctor must spend at least another four more years after medical school to become an ophthalmologist.
Unfortunately, some states are passing laws that allow optometrists to provide eye treatments that they aren’t qualified to do, and this can put patients at risk. Today, we are joined by Laurie Barber MD, an ophthalmologist and the chair of Safe Surgery Arkansas, to explain the differences between types of eye doctors and to help patients know how to protect their vision and their health.
Dr. Toni Manougian has done it all. Starting as an RN diploma graduate, Dr. Manougian obtained her bachelor's in nursing, followed by a master's degree as a clinical nurse specialist and then a degree as a critical care nurse practitioner, become deciding to become a physician.
Dr. Manougian explains the differences in training between the professions and tells aspiring physicians that it's never too late to become a physician if that is your dream.
Jennifer Bryan, MD, a family physician and the chair of the Board of Trustees of the Mississippi State Medical Association, discusses how her state created a coalition to block nurse practitioner scope expansion.
Patrice Little DNP discusses limitations in nurse practitioner education and explains why she created a platform to better prepare NP students. Doctor of Nurse Practice Little shares that while she wrote her scholarly project on "full practice authority" for NPs, she realized that many NPs who prioritize patient safety - herself included - don't want independent practice.
Patrice Little DNP's site: https://www.npstudentmagazine.com/
Many advocates of nonphysician practice argue that we need to allow nurse practitioners and physician assistants to practice independently because of a “provider” shortage. The mantra “access” seems to supersede all other arguments – including concerns over patient safety. But is ‘access’ really all it’s cracked up to be? The answer is no, and here is why. A 2018 Lancet study analyzing 137 countries found that more people die worldwide due to POOR QUALITY care than die due to a lack of access to care (reference below).
Linda Anegawa MD, an internal medicine and obesity specialist, discusses concerns over safety when non-physician practitioners provide healthcare independently without physician supervision, and describes her own story of how a trigger point injection by a nurse practitioner resulted in a punctured lung. Rather than sending her to the emergency department, the nurse practitioner told Anegawa that her shortness of breath was just "procedure anxiety." The truth was that the NP had caused a pneumothorax, or punctured lung, which can be fatal if left untreated.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Lancet article
M.E. Kruk, A.D. Gage, N.T. Joseph, G. Danaei, S. Garcia-Saiso, and J. Salomon. 2018. “ Mortality due to low quality health systems in the Universal Health Coverage era: a systematic analysis of amenable deaths in 137 countries.” The Lancet, 392, 10160, Pp. 2203-2212
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31668-4/fulltext?fbclid=IwAR1uwXVAsi-pOXSTEzJRTyX9nbdLtf8V-cGYMK6BuK_p77lTpNegyaCuUaI
Commentary: https://www.npr.org/sections/goatsandsoda/2018/09/05/644928153/what-kills-5-million-people-a-year-its-not-just-disease?fbclid=IwAR352fPMuZ9Z482Qb6_nFGQ-2bkcovCA3UdARsJDCvdbiHrLvhUasl0VxLo
Health policy experts note that there is a shortage of registered nurses across the nation and that 11 million nurses are needed to avoid a future shortage.[i] A lack of nurses puts patients at risk, with a 2002 report by the Joint Commission on Accreditation of Healthcare Organizations noting that “inadequate nurse staffing has been a factor in 24 percent of the 1,609 cases involving patient death, injury or permanent loss of function reported since 1997.”[ii]
One of the reasons for the bedside nursing shortage is the growth of the nurse practitioner model. It is estimated that the transition of nurses to nurse practitioners has reduced the number of practicing registered nurses by 80,000 nationwide, without a clear plan to replace those positions.[iii] While organizations such as the Institute of Medicine have called for nurses to expand their education to become advanced practice nurses, little emphasis has been placed on how these bedside nurses who go on to become nurse practitioners will be replaced.
The COVID19 pandemic has created a particular urgency for more nurses. In fact, so much so that Adventist Healthcare recently posted a call for physicians to be trained to act as nurses. We are joined again today by Dr. Natalie Newman, a California emergency medicine physician, patient advocate, and blogger to discuss the bedside nurse shortage, and the unimaginable call for physicians to work as nurses.
Follow Natalie Newman, MD at: https://twitter.com/Suburbanbella
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
[i]Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2020 Mar 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/
[ii]Ibid.
[iii] Auerbach DI, Buerhaus PI, Staiger DO. Implications of The Rapid Growth of The Nurse Practitioner Workforce in the US. Health Aff (Millwood). 2020;39(2):273‐279. doi:10.1377/hlthaff.2019.00686
On September 29, 2020, the state of California passed AB 890, a bill allowing nurse practitioners the right to practice without physician supervision. The bill received widespread support from groups that benefit from the use of non-physician practitioners, including hospitals and community health centers. Despite opposition from physicians and other patient advocates, the bill was passed with large margins and was signed into law by Governor Gavin Newsome.
Today emergency medicine physician Dr. Natalie Newman joins us to discuss the implications of nurse independent practice in California, one of the largest and most populous states in the Union. Dr. Newman is not only a practicing physician in California but also an outspoken patient advocate and prolific writer who blogs at Authentic Medicine.com.
Follow Natalie Newman MD: https://twitter.com/Suburbanbella
Get the book "Patients at Risk!"
In April 2020, Beaumont Health, Michigan’s largest healthcare system, made the decision to terminate its established anesthesia group in favor of Texas-based NorthStar Anesthesia, a private equity firm that promised the health system lower staffing costs. According to reports, more than a dozen physicians and surgeons resigned from the hospital system due to concerns over NorthStar’s reputation.
NorthStar’s contract began on January 1 of this year, and on January 25, Eric Starkman, a reporter at Deadline Detroit, reported the death of a patient due to an anesthesia-related complication during one of the most routine medical procedures: a colonoscopy.
Did the replacement of Beaumont's anesthesia team by a private equity firm contribute to the death of this patient? Not only is Beaumont not talking, but according to reports, staff members are being threatened and intimidated into silence.
To help us we will discuss how private equity takeovers in medicine may be harming patients, and what you can do to protect yourself, we are joined by Karen Sibert MD, Clinical Professor in the Dept of Anesthesiology and Perioperative Medicine at UCLA, and a past president of the California Society of Anesthesiologists.
Dr. Sibert's advice to all patients undergoing anesthesia: "Ask, 'who is my anesthesiologist?' And if the answer is, 'there isn't one,' they should leave." Further, "if there isn't a physician overseeing your anesthesia care, I can't reassure you that's going to be a safe situation. I think that every patient has a right to know who is taking care of them. There should be complete transparency, and I think physician-led care is the safest care."
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Dr. Karen Sibert's blogs: https://apennedpoint.com/how-could-a-patient-die-from-anesthesia-for-a-colonoscopy/
https://www.kevinmd.com/blog/post-author/karen-s-sibert
One of our personal favorites, which we cite in our book: https://www.kevinmd.com/blog/2011/11/unsupervised-anesthesia-care-nurse-anesthetist-threat-patient-safety.html
In our last episode we discussed the rapid growth of nurse practitioner training programs and some of the challenges this has caused in ensuring that nurse practitioner graduates receive adequate clinical training to care for patients. Today we continue to explore concerns about nurse practitioner quality of education, as well as a new trend for nurse practitioners to seek work in cash-pay type practices, including opening medi-spas, infusion centers, medical marijuana clinics, and so on.
To help us explore these issues, we are joined again by Rayne Thoman, a registered nurse and former NP student who works to expose unethical nurse practitioner training and practice.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Physicians, join us at physiciansforpatientprotection.org
There are over 400 nurse practitioner schools in the United States, with nearly HALF of these programs promoting online training—ranging from 50-100% of required academic training sessions. Some of these programs offer accelerated training, allowing students to become an NP in as little as 2 years, others offer flexible schedules with part-time programs allowing students to work full-time while they attend school. In contrast, there are just 179 medical schools producing physicians in the United States. None of them are online, and there are no part-time medical schools.
Why has there been such a proliferation of nursing schools, and with such a huge number and variability of program types, who are ensuring that these programs are producing qualified medical clinicians?
To help us explore these issues, we are joined by Rayne Thoman, a registered nurse who left nurse practitioner school when she discovered serious problems in the educational standards.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
The pathway to becoming a licensed physician in the United States requires nine to eleven years of formal education, and all physicians are required to pass a series of three high stakes standardized examinations called the United States Medical Licensing Examination (USMLE) before they can be licensed as to practice medicine. Most physicians also go on to become board-certified in their specialty field, which requires an additional examination following their residency or fellowship training. Compared to physicians, nurse practitioners and physician assistants have a far shorter course of training, and both are required to pass one standardized examination to be licensed to practice.
In 2008, the National Board of Medical Examiners offered down a simpler version of the USMLE Step 3, an examination all physicians take to receive a medical license. The pass rates for DNP candidates ranged from 33%-70%, and the experiment was discontinued in 2014 due to "low utilization."
Roy Stoller DO, an otolaryngologist and board examiner, joins Rebekah Bernard MD and Niran Al-Agba MD in a discussion of the differences between the exams that medical doctors and nurse practitioners and physicians assistants take.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Psychiatrist Torie Shatzmiller Sepah MD discusses her experiences as a chief psychiatrist at the California Department of Corrections, and her role in the "Golding Report," a whistleblower report by Michael Golding MD that alleges improper psychiatric care of inmates. Complete report here: https://www.scribd.com/document/392536943/Dr-Michael-Golding-California-prison-report-on-mental-healthcare
This episode contains brief graphic descriptions of inmate harm as well as physician suicide. If you are having any thoughts of self-harm, please call your physician or the suicide prevention lifeline immediately.
Physicians, medical students, and resident/ fellow physicians may also obtain free and confidential help through the Physician Support Line, a service offered by volunteer psychiatrists 7 days per week. Call: 1 (888) 409-0141 or physiciansupportline.com to learn more.
Get the Patients at Risk book! https://www.amazon.com/gp/product/B08M9YJQR3/
Learn more about Physicians for Patient Protection: PhysiciansforPatientProtection.org
Dr. Torie Shatzmiller Sepah, a practicing psychiatrist, discusses the differences between psychologists and psychiatrists, and the increasing trend of allowing psychologists to prescribe medications.
Get the book Patients at Risk: https://www.amazon.com/gp/product/B08M9YJQR3/ref=dbs_a_def_rwt_bibl_vppi_i0
To learn more about cognitive behavioral therapy, Dr. Sepah recommends the book "Thoughts and Feelings" - https://www.amazon.com/Thoughts-Feelings-Taking-Control-Moods/dp/1684035481/
Physicians: Join Physicians for Patient Protection - physiciansforpatientprotection.org
Corinthia Davidson-French shares the story of her son's missed diagnosis of aplastic anemia after multiple visits to an FNP at the local clinic. We also discuss racial disparities in the healthcare system, and what patients can do to advocate for their own medical care.
Learn more about becoming a bone marrow donor at: BeTheMatch.org.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Citations:
Goldberg GA, Jolly DM, Hosek S, Chu DS. Physician's extenders' performance in Air Force clinics. Med Care. 1981;19(9):951‐965. doi:10.1097/00005650-198109000-00007
Morrison F, Shubina M, Goldberg SI, Turchin A. Performance of primary care physicians and other providers on key process measures in the treatment of diabetes. Diabetes Care. 2013;36(5):1147‐1152. doi:10.2337/dc12-1382
Kurtzman ET, Barnow BS. A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers. Med Care. 2017;55(6):615‐622. doi:10.1097/MLR.0000000000000689
Gerald "Jay" Baltz, a psychiatric mental health nurse practitioner who is being investigated by the California Board of Nursing for an inappropriate sexual relationship with a patient who later took her own life, received his training at an online program that required a minimum of 500 clinical hours of experience for graduation. Baltz continues to provide psychiatry care to patients in California and Washington state, and since receiving a doctorate degree in nursing, he now advertises as "Doctor" Jay Baltz, DNP.
We are joined by psychiatrist Dr. Natasha Cervantes to discuss the differences in training between psychiatrists and psychiatric nurse practitioners, and why the difference in care can be a matter of life or death.
If you are someone you know is having thoughts of self-harm, help is available. Contact your physician immediately, or call the Suicide Prevention Lifeline for help at 800-273-8255.
Learn more about this issue - get the book Patients at Risk, available at Amazon and Barnes and Noble. https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Gerald "Jay" Baltz, a psychiatric mental health nurse practitioner, was investigated by the California Board of Nursing after allegations that he had entered into a sexual relationship with a patient who subsequently took her own life. The Board received this information in April of 2018, began its investigation, and filed a claim against Baltz on June 15, 2020. Today, six months later, Baltz continues to practice psychiatry as a nurse practitioner in California and in Washington state, where he has autonomous practice and does not require physician supervision. We are joined by psychiatrist Dr. Natasha Cervantes to discuss details of this tragic case.
If you are someone you know is having thoughts of self-harm, help is available. Contact your physician immediately, or call the Suicide Prevention Lifeline for help at 800-273-8255.
Learn more about this issue - get the book Patients at Risk, available at Amazon and Barnes and Noble. https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Dr. Robin Rose, a family physician who trained as a nurse and then nurse practitioner discusses the differences in education and training between the medical disciplines. Dr. Rose, who lives on an isolated island in Hawaii, describes challenges in obtaining physician-led care, especially for vulnerable populations living in medically underserved areas.
Physicians who speak out in support of physician-led care face repercussions. Steven Maron, MD, a pediatrician with 31 years of experience, was fired from United Community Health Center in southern Arizona after writing a newspaper article explaining the difference in training between a physician and a nurse practitioner. As Maron pointed out in his op-ed, while there are excellent and experienced nurse practitioners and physician assistants, their education and training are not the same as that of a physician. He suggested that to make an informed decision about medical care, the public should know who is treating them and the critical differences in the training of clinicians. Although Maron had worked for the community health center serving socioeconomically depressed children for 10 years without any disciplinary actions, he was terminated just days after the op-ed appeared in the Green Valley News. “I was told that my article stood in opposition to the principles of the organization, specifically the principle of mutual respect."
Get the book! https://www.barnesandnoble.com/w/patients-at-risk-niran-al-agba/1137936919?ean=9781627343169
Dr. Amy Townsend discusses the incredible lengths she went through to get the Texas Board of Nursing to act to stop a dangerous nurse practitioner after he caused 2 patient deaths.
Get the book! https://www.barnesandnoble.com/w/patients-at-risk-niran-al-agba/1137936919?ean=9781627343169
July 21, 2017
https://www.12newsnow.com/article/news/local/nederland-nurse-practitioner-says-allegations-of-inappropriate-use-of-hormones-are-unfounded/502-4583920
July 26, 2017https://kfdm.com/news/local/two-setx-families-hire-attorney-for-possible-legal-action-against-clinic-in-nederland
Oct 5 2017https://kfdm.com/news/local/nursing-board-accuses-optimum-health-owner-of-altering-document
Oct 24, 2017https://kfdm.com/news/local/angel-san-juan-breaks-optimum-clinic-raid-reports-live-on-investigation
Oct 24, 2017https://kfdm.com/news/local/law-enforcement-agencies-searching-nederland-health-clinic
May 23, 2018https://kfdm.com/news/local/kfdm-investigates-optimum-clinic
Sept 11, 2018https://kfdm.com/news/local/tmb-says-doctor-didnt-properly-supervise-two-nurse-practitioners-at-optimum-clinic
Jan 30 2019https://kfdm.com/news/local/southeast-texas-nurse-practitioner-surrenders-license-optimum-clinic-evicted
March 3 2019https://kfdm.com/news/local/owner-of-controversial-optimum-clinic-surrenders-nursing-license
Nov 14, 2019https://kfdm.com/news/local/kfdm-investigates-the-hiring-of-a-lamar-university-instructor-who-has-now-resigned
Drs. Rebekah Bernard, Niran Al-Agba, and Phil Shaffer break down the 2018 Cochrane Review "Nurses as Substitutes for Physicians in Primary Care," pointing out that of 9,000 studies reviewed over the last 50 years, just 18 were of adequate quality to include in a review of the subject. Of these 18 studies, just THREE were published in the United States, most contained high degrees of bias, had small sample sizes, were of short duration, and ALWAYS included physician supervision or nurses following physician-created protocols. Bottom line: there is no evidence that unsupervised nurse practitioners can provide the same quality of care for patients.
Drs. Rebekah Bernard and Niran Al-Agba are joined by Shannon Keaney, a nurse with 11 years of intensive care experience who recently graduated as a nurse practitioner. Shannon explains the differences between "brick and mortar" nurse practitioner training as compared to newer "diploma mills," and discusses why she thinks patients are best served when nurse practitioners practice with physician supervision.
Drs. Rebekah Bernard, Niran Al-Agba, and Phil Schaffer discuss researcher Mary Mundinger's recent Wall Street Journal letter, which argues that the nurse practitioners studied in her 2000 JAMA publication were practicing without physician supervision. The fine print reveals fascinating details left out of the headlines.
Referenced in the podcast:
https://www.youtube.com/watch?v=0BUGdOs74Q8&t=746s&fbclid=IwAR1hMRBFlgzV3gmgaBIDH744-5nX-RAa5-9xDd9nloDqQ4R0NTqOS5ESuoM