Physician Outlook

In California, the Doctor is Out

Update: The Doctor IS TRULY "out." AB890 passed on August 31, 2020 with 27 California State Senators voting "yes" and 3 voting "no." 10 senators abstained from voting. Nurse Practitioners were granted unsupervised full practice authority, free from physician oversight.

Over the last few decades in America, whenever insurance companies, hospitals, or government bureaucrats are faced with rising healthcare costs, the knee-jerk reaction seems to always be: "stick it to the doctors."


That might bring cheers from those of us who are openly or secretly jealous of M.D. specialists with high salaries, but in the end it will not only threaten our healthcare but cost us more anyway.


A bill just passed by the California state legislature that looks likely to be signed into law by Governor Gavin Newsom is the latest example of this disturbing trend.


AB 890 takes several key treatment privileges away from solely M.D.'s and passes them on to nurse practitioners. It's a plan so obviously meant to cut costs at the expense of healthcare quality that even the usually politically compliant American Medical Association  opposes it.


But in case you think this is just some example of "greedy" doctors worrying about getting squeezed out of some big payday, think again. Honest and ethical nurses from all over the country are aware of the fact that many of them will be asked to perform duties they're not trained to do, and their own dedication to good patient care is being threatened by this effort.


One such principled nurse who bucked the scare tactics and other intimidation efforts set forth by national nursing groups is Rayne Thoman, who joined a virtual news conference last week to express her concerns about the California bill.


Thoman dug down to the roots of the problem, which include the essential fact that many nurse practitioner degree programs don't even have qualified physicians -- or any physicians -- on staff as instructors during crucial periods of the instruction process. She also detailed some shocking facts about how non-challenging many of these degree programs truly are.


Thoman's stories are an important counter to the old persuasion trick of trying to make criticizing a bad policy tantamount to insulting good people. A lot of the lobbying materials in support of AB 890 use this kind of disingenuous tactic, defining the bill as a way to "acknowledge the value of nurse practitioners," as if giving them jobs they're not qualified to do is some kind of emotional vote of confidence and not doing so is a way of not recognizing the good work they actually do.


It's just the opposite, of course. Cost-cutting hospitals and state bureaucrats are trying to lower their financial liabilities by downgrading care, and they're relying on using nurses and their pride as a group as a human shield to get away with it.


And they're getting away with it because the hospital corporations are growing more financially and politically powerful every year. No industry, not even the banking sector, has successfully completed more mergers in America over the past 25 years than hospitals. Studies have shown for years that these monopolistic combinations are unsurprisingly raising patient costs, but now there's a growing amount of evidence that they're reducing the quality of patient care as well.


In other words, we're paying more for less in healthcare and AB 890 is just another move in that awful direction.


If you're looking for the government to step in and help, don't hold your breath. All those hospital consolidations have created a monster where any one of the newly combined conglomerates is most likely its home state's top employer. That means they have enormous lobbying power over governors, senators, and everyone else in public service.


Another issue is that many states are looking to do anything to cut their Medicaid and other healthcare liabilities. This is especially true in California which will seemingly do anything to reduce patient treatment options, including taking the lead as the state pushing the hardest to successfully approve pro-euthanasia laws back in 2015.


All the while, doctors in private practice keep getting the shaft. The same people arguing that healthcare quality and expertise would be compromised by loosening med school restrictions, increasing residency spots, and reducing the number of annual certification tests are the ones now pushing for nurse practitioners to take on responsibilities reserved for doctors only. In other words, when it comes to cutting state or hospital systems costs, they're all for compromising healthcare quality and expertise.


These efforts are all just part of an elaborate bait and switch scheme technocrats and too many healthcare middlemen have been engaging in for years.


Most of us learned in grade school that the price of anything is controlled by the law of supply and demand. But when it comes to healthcare, all of the so-called experts either focus only on efforts to reduce demand with unethical rationing plans (hello, socialized medicine), misleading programs like Obamacare that conflate healthcare with health insurance, or substituting good healthcare with weak replacements like this bill in California.


All of this shouldn't be confused with positive innovations like tele-medicine practices and the growing number of cloud-computing/Internet-enabled "house call" services that put more patients and real doctors together. Innovation isn't the enemy here; the problem is presenting a lower quality care and less-experienced caliber of caregiver as something they're not.


The sick joke is that this won't end up saving any money anyway. Remember that the cost of mistreating any patient condition is much higher in the long run because that same patient is that much more likely to return to the system with worse problems. It's a classic case of being "penny wise and pound foolish."


But that's what AB 890 is all about. It's not about empowering nurses or sticking it to "rich" doctors. It's about hospitals conglomerates and irresponsible state bureaucrats looking to save a few short-term bucks at the expense of patients who need physician care.


It may be too late to stop this mess of a bill from becoming law in California. But sometimes California's mistakes can serve as a useful warning to our other 49 states. America's best doctors and concerned patients may have come to this fight a little late, but a strong effort now could stop this California wildfire from spreading anywhere else.


This article was first published on Jake Nowak's LinkedIn page and was republished with his permission on  For more information about AB890 and other issues important to maintaining the physician-patient relationship please visit Physicians For Patient Protection.

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