103 episodes
Patients at Risk Rebekah Bernard MD and Niran Al-Agba MD
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- Health & Fitness
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4.2 • 243 Ratings
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Patients at Risk exposes the political maneuvering and corporate greed that has led to the replacement of physicians by lesser trained practitioners, including nurse practitioners and physician assistants. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for our nation’s healthcare guardians continue to decline—with deadly consequences. This is a story that has not yet been told, and one that has dangerous repercussions for all Americans.
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JOURNAL CLUB: Article claims that NPs, PCPs have same rate of inappropriate prescribing to seniors
In today's episode, Teresa Camp-Rogers, MD, MS analyzes a study published in the Annals of Internal Medicine, the journal of the American College of Physicians, entitled
Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care Physicians
The article, which seems to call for an expansion of unsupervised practice for NPs, contends that NPs and physicians showed no differences in inappropriate prescribing to seniors based on Beers criteria, however, notes that NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing.
Dr. Camp-Rogers points out that since most NPs are practicing under physician supervision, with an estimated 2-6% of NPs practicing without physician supervision, this study may simply prove what other studies have established: the physician-led care model works - NOT that unsupervised practice is safe. Further, she argues that this study begs a follow-up question: with such variation in potentially inappropriate prescribing by NPs, what do we know about which NPs were in the top and which were in the bottom?
https://www.acpjournals.org/doi/10.7326/m23-0827
Get the books! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/
PhysiciansForPatientProtection.org -
Doctors' Day revisited: What has changed in the last three years?
Three years ago, we aired a podcast criticizing Doctors' Day posts from hospitals and healthcare organizations that included non-physicians and referred to physicians as 'providers.' Fast-forward to today, and some organizations (but not all!) seem to have gotten the message.
Happy Doctors' Day to all physicians - thank you for your sacrifice and dedication to patient care!
PhysiciansForPatientProtection.org -
"I didn't know how bad it was:" NP pens report on NP education (Part 3)
John Canion is an experienced nurse practitioner working within nursing for years to improve NP education. Frustrated with the lack of positive change from NP leadership, he penned the "2023 Report on Nurse Practitioner Education and the Need for Change," which outlines the current state of NP education and proposes solutions that harken back to the original days of NP training.
Canion suggests:
- At least 2 years of RN experience before starting NP school
- Increased standards for entry, including minimum GPA requirements
- Standardized, rigorous education and program-vetted preceptorship
- An increase to 2,000 hours of base NP training and an additional 4,000 hours of training within a specialty (Family, Psych, ER, etc).
He writes, "We need a pause on independent practice or 'full practice authority' for NPs until our education has been fully reviewed."
Read the entire report here:
https://jcthenp.substack.com/p/2023-report-on-np-education-and-the
PhysiciansForPatientProtection.org
PhysiciansForPatientProtection.org -
"I didn't know how bad it was:" Nurse practitioner publishes report on the dismal state of NP education and need for change (Part 2)
John Canion is an experienced nurse practitioner working within nursing for years to improve NP education. Frustrated with the lack of positive change from NP leadership, he penned the "2023 Report on Nurse Practitioner Education and the Need for Change," which outlines the current state of NP education and proposes solutions that harken back to the original days of NP training.
Canion suggests:
- At least 2 years of RN experience before starting NP school
- Increased standards for entry, including minimum GPA requirements
- Standardized, rigorous education and program-vetted preceptorship
- An increase to 2,000 hours of base NP training and an additional 4,000 hours of training within a specialty (Family, Psych, ER, etc).
He writes, "We need a pause on independent practice or 'full practice authority' for NPs until our education has been fully reviewed."
Read the entire report here:
https://jcthenp.substack.com/p/2023-report-on-np-education-and-the
PhysiciansForPatientProtection.org
PhysiciansForPatientProtection.org -
"I didn't know how bad it was:" Nurse practitioner publishes report on the dismal state of NP education and need for change (Part 1)
John Canion is an experienced nurse practitioner working within nursing for years to improve NP education. Frustrated with the lack of positive change from NP leadership, he penned the "2023 Report on Nurse Practitioner Education and the Need for Change," which outlines the current state of NP education and proposes solutions that harken back to the original days of NP training.
Canion suggests:
- At least 2 years of RN experience before starting NP school
- Increased standards for entry, including minimum GPA requirements
- Standardized, rigorous education and program-vetted preceptorship
- An increase to 2,000 hours of base NP training and an additional 4,000 hours of training within a specialty (Family, Psych, ER, etc).
He writes, "We need a pause on independent practice or 'full practice authority' for NPs until our education has been fully reviewed."
Read the entire report here:
https://jcthenp.substack.com/p/2023-report-on-np-education-and-the
PhysiciansForPatientProtection.org -
The Assistant Physician (AP) - A pathway to independent practice?
In part 2 of my discussion of the Assistant Physician (AP) role, Dr. Keith Frederick meets Dr. Liz Troilo, who benefited from his legislation. After working as an AP, Dr. Troilo matched into residency and now provides critical access care as a Family physician in Missouri. Dr. Frederick proposes a possible alternate pathway to independent practice for physicians other than formal residency training.
Learn more about the importance of physician-led care - https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438
https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
PhysiciansForPatientProtection.org
Customer Reviews
Best podcast on scope creep hands down
Patients At Risk podcasts is the most informative podcast out there on scope creep. In addition, they discuss issues around the corporate practice of medicine, educational differences between NPs/PAs/Physicians, legislation around scope creep, better options for filling the manufactured “physician gap”, cases of patients mismanaged by non-physician practitioners, debunking poorly done studies defending scope creep, etc. They also provide information on how the public can become more informed and more effective at advocating for themselves. Their huge range of guests are fantastic. One comes away feeling more enlightened about the deficits in our health care system. Always a must-watch or must-listen podcast.
Butthurt mid-levels using one star reviews as copium
We all know any health care professional can make errors. Time and again we see physician errors studied and shown to be failures of systems that individuals cannot be totally blamed for. See the Institute of Medicine's landmark report Too Err Is Human, followed by Crossing the Quality Chasm and subsequent reports.
Instead of taking greed out of the system, the health care corporate industrial complex started banking on mid-levels and other greedy entities took advantage of this to create diploma mills pumping out thousands and thousands of undertrained individuals brimming with Dunning-Krueger effect.
Ultimately it's greed and capitalism to blame, not mid-levels themselves. But patients should know their lives are just nickels and dimes in this setup. Thanks for helping patients make informed choices
Nurses save MDs’ licenses daily
Let’s start a podcast to call out how many MD licenses would be revoked if nurses weren’t here to catch their MANY mistakes. So focusing on NP and PA mistakes is distasteful and makes you look like sour individuals. Why not spend your time lobbying to put out more MDs or spend time teaching and helping NPs and PAs so they succeed and more individuals are able to access quality care in a TIMELY manner.
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