Risky Business

Risky Business


We can not continue to idly stand by as young, under-educated and under-trained non-physician providers are being put in positions by administrators and insurance companies to care for patients because it is a less expensive way of delivering care.

Medicine is a “team sport.” ALL members - physician assistants, nurses, nurse midwives, nurse anesthetists, CRNAs, nurse practitioners and physicians - play vitally important roles, with patient outcomes dependent on excellent communication skills and coordination between all of the team-mates. A well functioning medical team puts patients in the center of every play, and the physician in the lead role. The patient is THE reason that the game is played.

The increasingly pervasive title of “provider” has permeated all of healthcare. Normally, I prefer to avoid using the word. It gets under my skin. In her 2018 article titled “Nope, “provider” still doesn’t work,” Dr. Jennifer Weiss hit the nail on the head and aptly described how the word makes most physicians feel. “Use of the term has been found to actually reduce morale, worth, purpose, and results in already overworked doctors finding less meaning in the work that they do.”

Why, then, did I choose to use the word “provider” in the title of this article? Because whether you are a physician assistant, nurse, nurse midwife, nurse anesthetist, CRNA, nurse practitioner or a physician, we are ALL being played.

We are collectively being used as pawns in an elaborate scheme to redefine healthcare - for profits at the expense of patients. Whoever is at the helm has been opaquely hiding in the shadows, and not being transparent about their motives. We need to all be wary of this “Oz” behind the curtain who has brought us clunky EMRs, MACRA and other unattainable quality metrics, meaningless Press-Ganey surveys, higher malpractice rates and payouts, ridiculously high deductibles, narrow provider networks, rising drug costs, and collusive Group Purchasing Organizations and Pharmaceutical Benefit Managers.

We need to be brutally honest about the many different types of “providers” that comprise today’s modern healthcare team. We can not continue to idly stand by as young, under-educated and under-trained non-physician providers are being put in positions by administrators and insurance companies to care for patients because it is a less expensive way of delivering care. These fiscally-driven changes are putting patients in harm’s way, and are causing a massive exodus of healthcare professionals who actually care about the Hippocratic Oath.  We are creating a generation of non-physician providers who will be haunted by guilt and imposter syndrome when they realize what has been done to them, and the harm it is doing to patients.

Two very brave physicians, Dr. Niran Al-Agba and Dr. Rebekah Bernard, have written a must-read provocatively titled book by the name “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare.” The doctors are also co-hosts of a podcast called “Patients At Risk.”The book and podcast should be required reading/listening for ALL pre-health students and are also  invaluable tools for anyone who has to navigate the system as a patient.

Through storytelling and factual patient-centered anecdotes, the book provides a very detailed account of the current state of American healthcare. Nurse practitioners are being churned out by online, non-standardized programs where a mere 500 hours of self-directed clinical shadowing allows the nurse to earn a degree. All graduates are being encouraged to obtain a “DNP” degree so that they can call themselves “Doctor” in the clinical setting. Patients are already confused when they intersect with the many members of a healthcare team, and it is frankly intentionally disingenuous and manipulative to have someone in a long white coat who introduces themselves as “Dr. So-and-So” misrepresent themself as the team leader.

The book unfortunately does not go into great depths on how far-reaching the political maneuvering and corporate greed is, but once we all “pull back the curtain” together and realize that we are all being played, we can sit down to work together to take back what has become a very broken medical system.

Many patients are being harmed at an alarming rate--with some even dying-- because non-physician providers “don’t know what they don’t know.” Patients and families who lose loved ones have very little recourse because in the majority of states the Boards of Nursing, not the Boards of Medicine, have jurisdiction over non-physician nursing providers. Unsupervised “Full Practice Authority” has passed in at least half of the United States and is constantly being introduced as legislation in the remainder. A run-away train is careening down the track, and we need to have the guts to speak out and reverse course. We need to stop allowing ourselves to be manipulated by profit-driven corporations and put our patients first. 

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