13 Dec Right Now…
Every single day physicians are fighting a battle, although many of us may not yet realize it.
While only 19,000 new physicians graduate from medical school per year, nursing programs are churning out nurse practitioners (NPs) at a rate of 23,000 per year. With Physician Assistants (PAs) graduating about 7,000 per year, the number of non-physician providers (NPPs) may eventually overtake the number of physicians in the United States.
NPs are not just growing in number. Politically-savvy NP organizations have made powerful friends and allies with legislators through lobbying and relationship-building, which has allowed them to gain unsupervised practice in twenty-three states and the Veterans Administration. NPs have also learned how to aggressively court the public, with campaigns like “We ChooseNPs” promoting NP-led care.
Even PAs, the doctor’s traditional ally, are challenging the need for physician-led care. Instead, they proudly proclaim: “Your PA can handle it.” Chafing at being labeled as assistants,efforts are underway to rebrand their name, with a new mantra: “Instead of saying Physician Assistant, ‘just say PA!’”
Corporate Medicine Hurts Us All: Patients and Physicians
Corporations have taken advantage of this flood of new “providers” to replace physicians with lesser-paid (and trained) individuals – or have forced physicians to supervise under threat of being fired. Often, patients have no choice of health care provider, particularly those living in underserved areas, where health centers are mandated to hire NPPs.
But there is a price to pay for sacrificing education and the 20,000 hours of training that physicians receive. That price is patient safety.
Near-misses go unreported
While non-physician providers (NPPs) purport to provide similar patient outcomes to physicians, none of these studies are long term or of high quality, and many other studies show concerns over increased ordering of tests, unnecessary procedures and referrals, and excessive medication prescribing.
As practicing physicians, many of us are identifying incidents of patients being endangered by poorly trained NPPs. With no official reporting site for these “near-miss” incidents, PPP has become a repository for case reports of patient endangerment, including near-misses and actual harm.
Colleagues, you are not alone
Through our PPP forum, many of us have awoken to the danger of NPP practice and are sounding the alarm. We are also realizing that we are not alone.
As one founding member put it:
PPP opened my eyes… This group has put the power back in our hands. It empowered us to say no. For decades physicians were respected and the leaders. Somewhere along the way we lost that. The only way we get that back is to band together and put our demands forth. We are stronger in large numbers. We don’t have a choice. If we fail, the career we chose will be lost as we know it.
The time is NOW for action
RIGHT NOW, it’s personal. NPPs are misdiagnosing and mismanaging our patients and loved ones with little or no physician oversight. Right now, the federal government is urging states to loosen scope of practice laws, in the mistaken belief that this will increase access and lower costs in healthcare. (Stay tuned as we debunk those myths in future posts.) Right now, we’re facing an insidious crisis in U.S. healthcare that few outside this group are talking about. Right now, we need to protect our ability to practice our expertise without the threat of being replaced or overridden by someone with less than 5% of our training. Right now, we need to ensure that the next generation of physicians is trained BY physicians and not by PAs and NPs with titles of “doctor” or “clinical instructor of medicine”. Right now, PPP is laser-focused on one issue, an issue that threatens patient care and the very core of our profession. Right now, PPP is the strongest grassroots organization to champion physician-led care in the U.S., with almost 10,000 physician members who are dedicated to the cause. Right now, PPP needs a revenue stream to further its efforts in education,advocacy, and research. Right now, PPP needs ALL OF US to unify, commit, and take this movement to the next level.
Dr. Anita Thomas
Posted at 00:08h, 06 FebruaryI’m very surprised how you lump NPs and PAs together. COMPLETELY different training model, for instance. PA students usually attend the same lectures with second yr med students and rotations with third and fourth year. In not one state can PAs practice without physician supervision, and in fact the majority practice in various specialties or first assist. Only 25% work in primary care. Perhaps you should read more about the unique differences between the professions and talk to people outside of your comfort zone. Just a thought
PPP Admin
Posted at 01:34h, 06 FebruaryThank you for your comment. We are very much aware of the key differences in training between PAs and NPs. PAs are indeed trained in the medical model, while NPs train in a nursing model. However, you are incorrect that PAs aren’t seeking to practice medicine independently. Perhaps you aren’t aware of the AAPA push for OTP (Optimal Team Practice)–it’s a model that looks exactly like the unsupervised, independent practice of medicine. Maybe you also aren’t aware that PAs are attempting to legislate themselves into unsupervised practice many states, and have legislated themselves into alternate arrangements in at least two states (NM and MI). We are advocates for physician-led, team-based care, which includes NPs and PAs.