The Certified Deceit and Exploitation of US Physicians

Guest Post by Wes Fisher, MD

For the past seven years, I have devoted a significant amount of my time to investigating and telling the true story of US physician “board certification.” That story has been one of deceit, private back-room deals, profiteering, and (worst of all in my humble opinion), the exploitation of working physicians and the patients for whom they care.

This writing has not come without its personal and professional costs, but when the story is one that affects the corruption of the largest single contributor to the US economy, what else should I have expected?

As I reflect on what this side job has exposed, it would be naive and dishonest to suggest that physicians are exempt from bearing some responsibility for rising healthcare costs in America. But it may go much further than that: our medical profession and its hallowed physician education regulatory system comprised of the unchecked Accreditation Council for Graduate Medical Education (ACGME) might be the very reason things were allowed to become so out of control. Our non-profit tax laws with their opaque reporting requirements have allowed huge “non-profits” to go unchecked in America – and most of those “non-profits” are in healthcare. (Just take a stroll by the American Medical Association (AMA) building in downtown Chicago sometime to get a feel for the magnitude of the problem.)

Why should the physician education and credentialing systems in America be exempt from such corruption?

Well, they are not.

From the earliest reports of a multi-million dollar condominium purchase by the same non-profit organization that created the “Choosing Wisely®” campaign to promote health care cost savings, the hypocrisy of US board certification was laid bare.

Read full article: https://drwes.blogspot.com/2020/01/the-certified-deceit-and-exploitation.html

Malpractice Costs Will Soar if NPs are Deemed On Par With Physicians

Dear Administrator Verma,

Deeming non-physicians to be essentially equal in training and experience to physicians amounts to a dangerous experiment on American patients. It is improper and unethical for the federal government to be making such decisions regarding the scope of practice of medical professionals.

I have spent over 40 years as a complex litigation specialist. Handling over 35,000 malpractice claims. It seems the law of unintended consequences is at play. Currently the “Captain of the Ship” doctrine limits liability to allied health personnel. It also limits professional and legal liability costs. Placing nurse practitioners and Physician assistants on par will indeed lead to greater claim frequency and increased legal costs. Rates for all providers will increase. In fact underwriters will increase offices with PA’s and NP’s. We could see malpractice costs for internal medicine practices rise from $1-3,000 to $9-12,000 per allied health professional .

We saw the law of unintended consequences occur with EHR and once down that “rabbit hole” there is no return. There is both a patient and physician expense that has not been calculated.

Likewise it is irrational and counterproductive to pay a minimally trained person the same as a highly trained, experienced person. If the reimbursement is the same for poor quality as for good quality, but the poor quality costs less to provide, the entities that degrade quality have a competitive economic advantage. Medicare’s existing price controls are already impeding patient access to high quality care and should not be exacerbated by additional flawed policies that further disregard important differences between practitioners. 

The bottom line is that patients’ lives are at risk. The federal government should follow a policy of “first do no harm.” It violates this principle to impose top-down edicts declaring that non-physicians are qualified to practice medicine. I urge the federal government to reject such policies.

Peter Leone

President, Edge Professional Liability Services https://edgepro.net/

Non-physicians Practicing Medicine is Dangerous and Deceptive

CMS wants more input on scope of practice regulations, reports Health Leaders Media.

Take a few minutes and write a comment.  Tell CMS that non physicians practicing medicine is dangerous and deceptive.  There will be unintended consequences of diminished medical school attendees and mass firing of employed physicians for cheaper substitutes.  Nursing is Not Medicine and it is deceptive for hospitals to deny patients access to physicians. 

Comments should be sent to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by Jan. 17, 2020.

We need your voice.  Its now or never.  If Section 5 is not removed…your tomorrow will be a very different world.

Additional Resources:

“There are absolutely no validated scientific studies that have shown the safety and efficacy of non-physicians [with as little as 3% of the training of physicians] practicing independently of physician supervision.”

https://www.physiciansforpatientprotection.org/ppp-responds-to-executive-order-regarding-pay-parity-and-scope-of-practice-offers-solutions/

“After residency, a physician has accrued a minimum of 20,000 or more hours of clinical experience, while a DNP only needs 1,000 patient contact hours to graduate.”

https://www.physiciansforpatientprotection.org/md-vs-dnp-the-difference-of-20000-hours/

“Compare the Education Gaps Between Primary Care Physicians and Nurse Practitioners”

https://www.tafp.org/Media/Default/Downloads/advocacy/scope-education.pdf

HR 3708: Is Pre-Deductible Coverage of Direct Primary Care a Feature or a Bug of The Primary Care Enhancement Act?

Aren’t HSAs intended to empower patient choice? Enabling plans and employers to influence the patient’s selection of primary care physician seems antithetical to this purpose.


DPC practices are rightly concerned about the numerous limitations HR 3708 would impose on their innovative model.  Yet, the limitations on HSA-eligible DPC arrangements are needed “to keep the cost score estimate of the legislation down,” the flawed argument goes.

But the tax impact occurs when dollars are put into an HSA and not when they are spent, so why so much fuss? Yes, the bill would cause more people to become eligible to fund their HSAs tax-free. That would indeed be a source of lost tax revenue. However, wouldn’t the cost in lost tax revenue be about the same irrespective of how a DPC arrangement is designed, assuming patients are funding their HSA up to the modest limits allowed per year anyhow?

Continue reading

ACTION ALERT: STOP Legislators from Delaying Patient Access to Physicians and Facilities of Their Choice

NO To New Jersey Assembly Bill A5369 & S3816!

Following the example of Congress, the NJ Legislature has introduced a “Patient Protection Act” (A5369 / S3816) that is anything but protective of patient rights.

According to NJ Spotlight, “the proposal has drawn criticism from patient advocates and other healthcare experts who suggest that, in an effort to protect the business interests of Garden State hospitals, it could put patients in danger.”

What does this bill do? It erects a number of bureaucratic requirements that physicians would be required to fulfill before referring a patient to an out-of-state colleague or facility for needed medical care.

Here’s how Joe Nessa, Esq. explains it:

If passed, this legislation could have a devastating effect on patient care. Currently, physicians in New Jersey are free to refer their patients to world-renowned hospitals in Philadelphia, New York City, and across the nation for treatment. New rules imposed by the bill would require physicians to inform patients of the availability of in-state facilities even if they think their patient can receive better care elsewhere, notify the patient’s insurance company of the out-of-state transfer, and report the transfer or referral to the Department of Health. This addition of paperwork and red-tape will force physicians to make the easier, time-friendly decision of keeping their patients in-state, regardless of their thoughts on quality of care. Additionally, as if the above requirements aren’t enough, physicians would also be required to send quarterly reports of each out-of-state referral to their licensing board, accompanied by an explanation of the clinical necessity.

Earlier this summer, this bad legislation was being fast-tracked through the legislative process, and was quickly passed by the Assembly and a Senate Committee. It “has yet to be approved by the [full] Senate,” reports the Fall 2019 Edition of MDAdvisor. However, “[t]he sponsors are continuing to work on this legislation….”

Your help is needed to help STOP A5369 & S3816!  Here’s what you can do:

Call your NJ State Senator and Assembly Members. Tell them you are depending on them to stand up for patient rights and vote NO on A5369 and S3816. Patient care should not be put at risk to benefit the bottom line of special interests.

You can find their phone contact information here:
https://www.njleg.state.nj.us/members/abcroster.asp

If you don’t know who represents you, the legislature has tools to help you find out here:
https://www.njleg.state.nj.us/members/legsearch.asp

Medical facilities in NY and PA have put together a tool for sending e-mail messages to legislators which you might also consider using:
https://actnow.io/Y1rtnGO

Thank you for speaking out! Your voice makes a difference.

Call Your NJ Politicians Now to Vote NO on S4204! Physicians (and everyone else) in NJ will be unable to take side jobs as contractors.

“New Jersey’s law regarding independent contractors [will be] the most restrictive in the nation,” if the State Legislature passes S4204, reports JD Supra in an analysis of a ill-conceived bill ” that could decimate the state’s gig economy.”

The Jersey Conservative puts it this way:

Are you a photographer? A truck driver owner-operator? A freelance writer? A tree trimmer? A dog groomer? A lawyer? A locksmith? A tow-truck driver? A million other things? [e.g. a doctor] Yeah. You’re screwed.

https://www.jerseyconservative.org/blog/2019/11/22/trentonian-the-lives-of-hundreds-of-thousands-of-new-jerseyans-are-about-to-be-destroyed

Spurred by the growth of crowdsourcing apps like Uber and Lyft, this bill “could effectively end independent contract work for many residents in the state if passed,” concurs the Washington Examiner.

California passed a similarly controversial bill earlier this year. But unlike the California bill that exempted a broad array of professionals, including physicians and surgeons, from the law’s prohibition on independent contracting, the NJ bill has only very narrow exemptions.

As written, under the New Jersey bill, “doctors who contract with a health care group, an attorney contracted by a law firm or a political consultant contracted to a political campaign may not be able to [be considered an independent contractor],” concludes JD Supra.

Can such a draconian and un-American bill pass? It is being “fast-tracked for passage in the coming weeks,” according to the Jersey Conservative blog. And JD Supra “predict[s] it will [pass].”

Please speak out TODAY and ask your NJ legislators to oppose S4204: https://www.njleg.state.nj.us/SelectMun.asp

Read more about the implications of this awful bill: https://www.jerseyconservative.org/blog/2019/11/22/trentonian-the-lives-of-hundreds-of-thousands-of-new-jerseyans-are-about-to-be-destroyed

AOA’s Problematic Response to President Trump’s Executive Order

Friend of IP4PI, Richard Koss, D.O., writes in:

Below is the response from the AOA regarding the recent presidential executive order regarding Medicare.

Well they do make some accurate points towards the end of the letter there are many problems and issues that need to be brought out.

First. The federal government like most of America do not know what a DO or osteopathy is. Since this is a presidential executive order, does the President of the United States even know what osteopathy is? I doubt it! therefore the bureaucrats in Washington DC will not pay attention to this letter.

Second. The AOA does not speak for the 145,000 DO’s in this country. They can only speak for their membership which at this point is below 30% of all DO’s. since the AOA has not brought this information out to the membership and asked for support they cannot speak for any DO at this point. Likewise only 15% of MDs belong to the AMA. And again the AMA cannot speak for the vast majority of physicians in this country. Yet they do.

Third. Where in this response letter does the AOA expound on the difference between allopathic and osteopathic physician’s? And show our superiority in quality, cost containment etc. based on OSTEOPATHIC PRINCIPLES! Where does the AOA champion the use of osteopathic manipulative medicine in the care for seniors.

Interstate licensure Compact…NO!

Continue reading