You Have the Right to Know Who Is Treating You

Corporate, for-profit healthcare systems are increasingly replacing physicians with nurse practitioners (NPs) and physician assistants (PAs) to cut expenses and increase profit.

As a result, when you walk into a medical office, emergency room, or hospital, you may not know who is actually making the medical decisions about your care.

The difference matters.

Physicians complete 15,000–20,000 hours of rigorous, standardized, and supervised clinical training. In contrast, most NPs and PAs receive 500–2,000 hours of variable, often unsupervised clinical exposure.

That gap can mean the difference between an accurate diagnosis and a missed one — between a lifesaving intervention and a dangerous delay.

The Problem: It’s hard to know who is treating you in healthcare.

Read More >

Across the world, there are growing stories linking the trend of allowing non-physician practitioners to function without supervision with patient harm and, in some cases, death—underscoring the risks of removing physicians from critical medical decision-making.

  • Missed Pulmonary Embolism Diagnosis: A young actress tragically died after a blood clot was missed after two visits with physician assistants. Read more >
  • Missed Stroke Diagnosis: A nurse practitioner failed to recognize a stroke in a patient presenting with “the worst headache of their life” and patient left with significant brain damage. Read more >
  • Missed Leukemia Diagnosis: A nurse practitioner misdiagnosed 5 year old child’s leukemia as a common cold. Read more >
  • Patient Deaths in the NHS: Six patient deaths were linked to physician associates being used as substitutes for fully trained doctors. Read more >
  • 25 patients harmed and one dies after NP allowed to perform ERCPs. Watch >

Not always resulting in dramatic individual injuries, there have been studies about the less optimal care, longer delays in diagnosis or treatment, and higher chances of unnecessary tests or referrals of care provided by non-physician practitioners—all of which undermine safety and inflate costs.

A study out from a large multispecialty clinic, the Hattiesburg Clinic, revealed that “in hindsight and “with a wealth of internal data,” which includes cost data on more than 33,000 patients enrolled in Medicare, “the results are consistent and clear: By allowing APPs to function with independent panels under physician supervision, we failed to meet our goals in the primary care setting of providing patients with an equivalent value-based experience.” They found that NP spending, when risk-adjusted for patient complexity, was about $28.5 M annually greater than that of physicians. The bulk of the higher cost came from increased test orders, specialist referrals, and more patients being sent to emergency medicine departments. At the same time physicians provided better care on nine of ten quality measures, with double-digit differences in flu and pneumococcal vaccination rates. 

The Problem: You are at risk of personal injury

Here’s the truth:

  • Every high quality study comparing NPP care to physician care has involved some degree of physician supervision
  • These studies were simple, low-risk primary care visits and often for a specific medical condition that had a physician protocol. Complex cases and undifferentiated (acute complaints that were not yet diagnosed) were excluded from studies. 

“What is conspicuously missing, despite decades of unsupervised practice in many states, is a single high-quality randomized controlled trial demonstrating that nurse practitioners or physician assistants can safely and effectively practice without physician involvement.” – Rebekah Bernard

The fact that such research still does not exist should raise serious concern. If independent practice were truly safe and effective, there would be solid, reproducible data by now.

Problem: Your Personal Injury May be Judged at a Lower Standard of Care

It can be harder for you to obtain fair compensation and for oversight mechanisms to align with physician‑level expectations.

Case Examples: 

  • In Simonson v. Keppard (2007), a court held that the standard of care for a nurse practitioner “must not be measured by the standard of care for a physician or surgeon.” (Physicians for Patient Protection)
  • In Lattimore v. Dickey (2015), the court reaffirmed that “a nurse’s conduct must not be measured by the standard of care required of a physician or surgeon, but by that of other nurses in the same or similar locality and under similar circumstances.” (Physicians for Patient Protection)
  • In a reported case involving an infant treated by an NP, the board found that the NP failed to assess and document critical vital signs — but again judged against what an NP in similar circumstances would have done, not what a physician would have done. (NSO)

Check out Patients at Risk Episode >

The Problem: Difficulty Accessing a Physician

Federally capped physician residency training spots. 

The number of federally funded residency training slots has remained capped since 1997. While medical schools have increased enrollments and many immigrant physicians seek to train in the United States, this cap means thousands of medical graduates are unable to complete residency training, which is required for physicians to practice independently and get credentialed with insurance plans. 

Moral Injury.

At the same time, a large portion of the physician workforce is dealing with moral injury from dealing with the healthcare system, and either reducing clinical hours or leaving medicine altogether for non-clinical work or early retirement. 

Administrative Structure. 

Many offices create systems that direct patients a certain way due to scheduling and routing practices. Many offices build the non-physician practitioners schedule to be longer appointments with patients, whereas physician schedules are shorter. Physicians are expected to see more patients in less time, while much of their day is still consumed by tasks like medication refills, prior authorizations, and filling out paperwork for FMLA. 

What are the Solutions?

We need more funding for physician residency training. 

Corporations using NPPs to replace physicians, instead of having the NPPs actually support physicians (as paralegals support lawyers) does not address these root causes, and cannot solve the physician-shortage issue

Allowing non-physicians greater ability to practice medicine without a license does not significantly increase access to care in rural areas. 

Evidence shows, despite promises, nurse practitioners have not moved to rural areas even after legislators removed physician supervision and collaboration. Despite over 20+ years of allowing NPPs to practice medicine unsupervised, studies in Arizona and Oregon have shown that neither state experienced any significant improvement in rural or primary care shortages. 

The Problem: Physicians’ Hands Are Tied by the System

Most physicians today are employees of large hospital systems or corporate-owned practices rather than independent professionals. Employment contracts often include strict non-compete clauses that can prevent doctors from practicing nearby for years if they leave. Starting an independent medical practice can take months or longer due to complex state regulations, licensing delays, and insurance hurdles, making it difficult for physicians to gain autonomy quickly in response to retaliation of reporting unsafe practices.

Physicians who raise legitimate patient safety concerns can face retaliation in the form of “sham peer reviews” — internal investigations that are used not to protect patients, but to silence or discredit physicians. Peer review was originally designed to ensure quality and patient safety, but in many hospitals today, it is misused to control “disruptive” physicians. Those who speak up about unsafe practices, corporate overreach, or patient harm can find themselves accused of “disruptive behavior” and subjected to internal reviews intended to discredit or remove them. These reviews can lead to suspension, loss of privileges, or lasting damage to professional reputation. These actions can be reported to the National Practitioner Data Bank (NPDB), and have an irreparably effect a physician’s career, even if the claims are unfounded.

Some physicians are particularly vulnerable because they rely on their employer for visa sponsorship. This dependence can make it extremely difficult to challenge unsafe practices or administrative overreach without risking their immigration status, employment, and ability to remain in the country — further tying their hands and limiting their ability to advocate for patients or themselves.

The Problem: NPs and PAs Are Speaking Up — But Their Organizations Aren’t Listening

Only 10% of NPs in the ER have any formal emergency training, and some family nurse practitioners (FNPs) can qualify for emergency NP certification with just continuing education credits. They conclude: “Until this variability is resolved, we conclude that NPs should not perform independent, unsupervised care in the ED regardless of state law or hospital regulations in order to protect patient safety.”

https://www.sciencedirect.com/science/article/abs/pii/S2155825622000102

“I didn’t know how bad it was:” Report calls for urgent change to NP education

https://youtu.be/d9fSUo2vR58?si=ARn8Ia3mln5oU4ze

Evidence shows that the majority of NPs themselves do not support independent practice without physician oversight – in a survey of nearly 400 NPs, 82% said new NP graduates are not competent for unsupervised practice.

Find Out How PPP Is Fighting for You

PPP is fighting for YOU to receive the very best care when you need it most by educating the public and legislators about the problems and offering solutions.

Become a Supporter