Going to plug one of my favorite books, but this needs to be something that every premed should read. Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare explains how corporate greed has led to the replacement of qualified medical professionals by lesser trained practitioners. It goes into detail about FPA, where NP’s and PA’s are pushing to practice unsupervised in their own clinics or urgent cares along with many other issues that are pushed through by AANP and AAPA lobbying.
Notes for the show:
> 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/
Hiya! You can check out this book, “Patients at Risk”, it is written by two prominent leaders of the PPP.
They are far from a lobby group. Just physicians caring about their patients and doing everything they can to change a system that is hurting them....
I am not a researcher, I focus on the differences in education between NPs, PAs and physicians. I belong to a group of physicians who oppose independent practice of non-physician practitioners. There are docs in the group who do research and understand the studies in depth. The studies that are out there have been reviewed ad nauseum. Of the ones that come close to NPs being unsupervised, they are done in Sweden. An extensive review of relevant studies are compiled in the book, "Patients at Risk, the Rise of the Nurse Practitioner and Physician Assistant in Healthcare(https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164), which was written by two of our members. We have shared this book with legislators who never review the studies, they just believe what they are told which is that there is no difference in outcomes between NPs and physicians, which is not true.
There is no way to have independent practice with NPs only seeing non-complex patients. Some patients who appear simple turn out to be complex. Patients present how they present. In addition, there is no oversight. In FPA states, not one regulatory, nursing or legislative body has re-assessed the quality of care being provided to the public by NPs practicing unsupervised. Not one state has followed up. It is simply an assumption that the care is sufficient. No one really knows.
Becoming a dues-paying member puts your money into the hands of an organization advocating for your future. PPP is smaller, leaner, and more focused than the AMA. The leaders of the organization wrote a book, the first of its kind, documenting scope creep in an objective manner.
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/ref=nodl_
Joining gives you the opportunity to connect with like-minded physicians who want to create a better future for us. You will be better informed about current scope creep legislation, the business of medicine, and how to legally protect your future.
Its a high value investment for any medical student, resident, or attending. We need to band together and stop this nonsense before its too late 💪💪💪
Love your username 😂
The new book Patient’s At Risk (https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_awdb_imm_t1_peVVFb5FREEND). Does a fantastic analysis of the articles included in the Cochrane review of this issue. And all the studies are flawed in their use to further the narrative of “just as good if not better” sinc every single one followed intensely supervised mid levels.
Also a really poignant comment was how it would never pass an institutional review board to do a true RCT of independent NP/PA to physician care beucase well... it’s deemed a risk to patients.
We should all be educating everyone we know about this. Share with them the book that came out yesterday: Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare by Niran Al-Agba and Rebekah Bernard
https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_apa_fabc_8eaTFbRV67HY9
Also join PPP! https://www.physiciansforpatientprotection.org/why-join/join-now/
If I may recommend a book for them to read as a lowly pre-med myself, this one is excellent
Buy this book. Read it. Give it to all your friends, they should read it as well.
Tell everyone that the difference between NP/PA and an MD are roughly 10.000 Hours of training, probably more. Also tell them that they're allowed independent practice after just 500 shadowing hours, where they just follow someone around. thats 3 months a 40-weeks.
Also, tell all your friends and family always specifically ask for a physician, not for a doctor. its actually very sad it has come to this. everyone knows, in an healthcare setting, a doctor is a laymen-term for physician and laymen simply don't know. this gets abused by NP/PA. its actually abusive if you think about it. you trick someone into consent, by misleading them on purpose and they are fully aware of it. thats actually rape.
The book referenced in this video is AMAZING. I could not put it down. Read it in one night. Here is the link to the book. Please leave positive book reviews on Amazon, B&N, Walmart, Google https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/ref=sr_1_1?crid=30Z92KSW6TWBS&dchild=1&keywords=patients+at+risk+the+rise+of+the+nurse+practitioner&qid=1607888754&sprefix=patients+at+%2Caps%2C372&sr=8-1
not sure if this is really inspired me to become a physician but i recommend patient at risk: the rise of nurse practitioner and physician assistant in healthcare
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Check this video out:Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare and the book is coming out this month...
Love this. We could add a “5.) Work on your bedside manners” many patients pick NPs for this exact reason.
To go with “3.)” pre order/purchase https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_awdb_imm_t1_n8aQFbEM267NZ
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare
https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_hNq7FbDM1B6AE
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glt_fabc_8TW5RQNNBDCD77050B13
I am not fluent on the history of either role, but I can lightly touch on their purpose today. I'm also guessing you don't have patient contact, so I'll phrase this with that in mind.
Let's use the emergency department (ED) as an example. In theory, PAs or NPs should be seeing low acuity patients such as 4s or 5s. '5' is something like a prescription refill or rash. An example of a '1' could be cardiac arrest.
That being said, what has happened is the American Association of Nur$e Practitioner$ (AANP, you'll see them frequently mentioned in this sub) and other groups have money on their minds. They actively lobby congress to expand scope of NPs. Using the ED example, this would allow them to function in the ED without direct physician supervision (or really any, depending on the state). They would be able to prescribe controlled substances, perform procedures, and other complete other complex tasks without any formal training in their NP program.
The problem with this is there are no strict standards or guidelines for accreditation of nurse practitioner programs. There are programs that are 99% online who send their students off on their own to find a preceptor (someone who the student can shadow such as an NP). There are rumors that even NP preceptors no longer accept students because of their incompetency and the poor quality of their programs.
There's a lot more that I don't have the time to touch on here, so see below!
​
If you are interested in learning more, I highly recommend the book Patients at Risk. I have not read it, but I listen to the Spotify podcast by the same name and authors.
Donate to your state and local PACs and:
PPP: https://www.physiciansforpatientprotection.org
AMA PAC: http://www.ampaconline.org
Political Advocacy: https://doctorsinpolitics.org
Buy and hand this book out to everyone:
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare
https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_vkp6Fb256HHND
A book was recently published about this issue.
Thank you for telling your story.
Thoughts:
1 - Read patients at risk (the book)
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
2 - Understand that a non-physicians may not be held to physician standards of care in a court of law.
https://sullivanlegal.us/nurse-practitioner-and-physician-assistant-standard-of-care/
3 - Get a copy of the Medical directive disallowing non-physician care for dx/tx. (Back of patients at risk book) in your medical charts.
4 - When scheduling, let the receptionist know that you and your husband are not ok with 2nd tier care (with more legal risk) and that you want to see the physician (MD/DO)
5 - review practices that do not allow you to schedule with a doc and let them know you are doing so.
Good luck! 🍀
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glt_fabc_YHXEGNZ3GAKB598B8952
Nope unfortunately. 20,000 hours is the minimum for a residency trained physician (which is the first time a physician may practice independently.) It is a huge gap in training that is a big legislative problem that puts patients at risk.
Here's a quick source: https://losangeles.cbslocal.com/2020/09/27/ab-890-nurse-practitioner-physician-oversight/ There are better sources but this was my quick googling.
I highly recommend this book if you're interested: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Sounds like an awful experience.
I would never allow any of my family to see a NP in any field - including primary care - for anything diagnosis or treatment related.
They are rarely well supervised (often inappropriately used by corporate medicine) and they never have the extensive formal standardized background and training needed to practice independently.
In addition, if a NP screws up they may not be held to the same legal standards of care as physicians. Patients may not expect compensation. Demand a real doctor. You get no discounts for seeing a lesser trained clinician.
See the book: $9 on kindle (many real life horror examples of NP care)
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
And website: https://www.physiciansforpatientprotection.org/
for more information and to report your story.
Buy this book.
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_CzKbGbGYRDS7A
How do you to feel about them NURSES taking your future job?
Things you can do:
Highly recommend this book for further information: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
Did this make you furious? Do you care about your future and that of your patients?
Things you can do:
1) Join and donate to the PPP: https://www.physiciansforpatientprotection.org
2) Buy and hand this book out to everyone: Patients at Risk
3) Donate to your state and local PACs
4) AMA PAC: http://www.ampaconline.org
Did this make you furious? Do you care about your future and that of your patients?
Things you can do:
1) Join and donate to the PPP: https://www.physiciansforpatientprotection.org
2) Buy and hand this book out to everyone: Patients at Risk
3) Donate to your state and local PACs
4) AMA PAC: http://www.ampaconline.org
Did this make you furious? Do you care about your future and that of your patients?
Things you can do:
1) Join and donate to the PPP: https://www.physiciansforpatientprotection.org
2) Donate to your state and local PACs
3) AMA PAC: http://www.ampaconline.org
4) https://doctorsinpolitics.org
5) Buy and hand this book out to everyone:
https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_vkp6Fb256HHND[Patients at Risk](https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_geG6FbE3KDNK1?_encoding=UTF8&psc=1)
If you care about your future and that of your patients:
1) Donate to your state and local PACs and:
2) PPP: https://www.physiciansforpatientprotection.org
3) AMA PAC: http://www.ampaconline.org
4) Political Advocacy: https://doctorsinpolitics.org
5) Buy and hand this book out to everyone:
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare
https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_vkp6Fb256HHND
If you care about your future and that of your patients:
1) Donate to your state and local PACs and:
2) PPP: https://www.physiciansforpatientprotection.org
3) AMA PAC: http://www.ampaconline.org
4) Political Advocacy: https://doctorsinpolitics.org
5) Buy and hand this book out to everyone:
Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare
https://www.amazon.com/dp/1627343164/ref=cm_sw_r_cp_api_glc_fabc_vkp6Fb256HHND
Sorry to respond late been swamped with exams. It is difficult. The AANP does not have strict overarching standards such as in medicine or law or accounting. I would prefer to send my children to only physicians (MD or DO).
To give you a perspective these are their boards. You take the exam until you get an appropriate # of questions correct. Really think about that. For NCLEX about 75 out of 265. Which is a 33% correct rate. That is a joke.
In other professions, such as the Bar exam or medical boards you take the exam and must get a certain % correct. Usually set to at least 70%.
(I will take 3 sets of boards BEFORE medical school ends, and then additional specialty boards that every physician takes every 10 years to keep up with the changes in medicine)
I would really like to stress though NPs can be great. But the current state of medicine is that the # of residents are capped. (Medicare provides the funding). Hospitals can have residents for essentially slave wages. Typical salary is about 50-80k but they are typically working 80 to 120 hours a week for several years. Some surgeons will work up to 11 years. But an attending physician can make 250K+ depending where you are.
Thus, there is a huge incentive to NOT increase resident spots because you will create more attending physicians.
NPs on the other hand can get their degree completely online with "supervised hours" (not actual legitimate clinical experience) in less than 18 months.
NPs will prescribe more drugs, order more tests, and send out more referrals. What does this mean? more money for corporate healthcare. Thus there is absolutely no incentive to do away with NPs. Look anywhere else in the WORLD, NPs do not exist. Why? Because healthcare should not be governed by money.
There are many great NPs. Many of whom I learn a lot from. But as a whole, would you want your own care to be under someone who is under-trained?
All in all, pretty screwed up situation. Lots of patients will continually be hurt and those of us in medicine often see horror stories of inadequate care all for the pursuit of the dollar.
I really wish we had socialized medicine and I wouldn't have to decide between drugs that simply cost less in consideration for my patient when I could just choose the best evidence based care.
[Side-note: I love Norway's model where medical students go to medical school for free, but their pay is just above the median income. Thus, physicians do not make much money ~ on par with teachers (though Norway teachers make MUCH more than American teachers). Therefore, the focus is simply on doing what you love which is caring for patients and your fellow man.]
Sorry for the rant.
$10 on kindle.
Or Barnes/Noble $28
Or Amazon print version $25
i will link this post here that you need and have not responded to yet.
also, it wasnt a dumb and hyperbolic comparison because that's what we're seeing in health care right now. Nurse Practitioners are gaining FPA in many states (or have gained it) while being underqualified for it. Only 3 studies have been conducted in the USA and all of them were under physician supervision. even under physician supervisino, NP's patients had higher complications. likewise, we do not want any underqualified expert whether that's a phd, md/do, or DNP in a position where they do not fit for the pandemic
the education difference between nurse practitioner and physician is huge due to the amount of years a physician dedicates their life to the profession.
i recommend this book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164
/u/readitonreddit34 wrote some points about this:
> I want people who watch this video to note a few things:
> - The AANP fought tooth and nail to prevent this clip from being aired. They mailed their members this email to try to prevent it from being shown. They actually mention this at the beginning of the video.
> - After the clip was aired, the AANP leadership posted a response. I linked it so you all can read it for yourselves but they basically sound the alarm of “how dare you attack frontline workers in a pandemic?” Without actually responding to any of the information presented. They basically use the pandemic and the death of the COVID patients to invoke outrage and cover up the problem.
> - The YouTube video has been unlisted. You can’t search for it. I am not sure why but I am assuming something nefarious.
> - If you want more information please visit Physicians for Patient Protection who is a grassroots organization that has been a voice of reason in this fight. You can also visit the American Medical Association who have only lately started speaking about this issue. You can also visit the American College of Emergency Physicians who have been vocal about this issue.
> - Read Patient At Risk it is the book written by Dr. Al-Agba (in the video) and Dr. Bernard. It goes into much more detail and with statistical evidence about this problem. Edit: somebody wanted me to comment about the amount and quality of the training difference between MD/DOs vs. NP/PA’s. The rough numbers are that MD/DOs get about 16,000-27,000 hours (depending on how much they choose to specialize) vs. NP/PAs get about ~ 500 hours. These hours are also not equal. Training for MD/DOs is rigorous and grueling. NP/PA hours are more or less shadowing. You can also read more about this in the book.
> - It is important to note that the issue isn’t the existence of nurse practitioners and physician assistants. Much like Dr. Agba says, there are many qualified ones that contribute positively to patient care. The problem is the IMPROPER USE of midlevel practitioners and the lobbying that’s going towards independent practice in order to cut corners and save healthcare corporations money. This is a view point that physicians, nurse practitioners, and physician assistants agree with.
> - You can do nothing. This problem probably won’t affect 90% of the avg Reddit users that see this post. You can like and move on. But one day, you or a loved one will get sick and will have to be seen in an urgent care or an ED and that person who presents themselves as doctor can make a mistake that can be fatal or injurious, what then?