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

NPs Running the ER: What Could Go Wrong? A Lot.

Guest post from Patrick Horn, M.D.:

I made a post on Physicians for Patient Protection (PPP) earlier this week about my personal experience with an NP that was negligent and could’ve easily cost my life, but I typed up a statement for use formally and have sent it to a lot of groups. If you feel it might help you in the fight against NP independent practice feel free to use it. You have my permission to us my story, my name, whatever you need. And I’m happy to discuss my story with anyone.

My name is Patrick Horn from Edmond, Oklahoma, and I wanted to share my story regarding a poorly trained nurse practioner that could’ve cost my life. I came into the Mercy Hospital ER, Oklahoma City, on Wednesday, 2/27/2019, as a trauma case after a severe MVA at approx 8am where the vehicle rolled into a very deep ditch on its side at high speed after losing control on the ice at the bottom of a steep hill in a rural area.

My truck hit the deep ditch/ravine so hard that both front wheels cracked off, air bags deployed, the truck flipped on its side and wedged into the large ditch. After seeing my vehicle, everyone at the scene has said I’m lucky to be alive, much less that I crawled out of the vehicle under my own power.

At Mercy ER, I never saw a doctor. Just an NP, Dawn Womack, APRN.  I came in complaining of severe spinal back pain and abdominal pain. She ordered a thoracic x-ray only and a zofran for the abdominal pain, and almost sent me out the door with Naproxen after misreading the x-ray as normal.

I asked that an MD radiologist read it before I was released and learned that I had fractured thoracic vertebrae per radiologist reading and CT confirmation.

She never bothered to do more imaging, including none of my c-spine nor my lumbar spine nor my abdomen nor my head, nothing. Seems like she really didn’t want to do a thoracic CT but did so based on what the radiologist recommended and based on my pushing for help. She just tried to get me out the door as quickly as possible. I get that they were very busy that day due to all of the ice slips and falls, but given the potential severity of my trauma after a severe MVA that probably should’ve killed me, this management is inexcusable.

No abdominal CT for the abdominal pain after the MVA, no complete spinal CT, no imaging of the cervical or lumbar spine, no head imaging, nothing. I could’ve been bleeding in my abdomen from a ruptured aorta, lacerated spleen or kidney, and she never would’ve never known.

I fractured my spine and she sends me out with a script for the weakest pain medication available simply because she’s an NP and refuses to ask her supervising MD to write for something stronger. I’m still in pain and suffering.

I’m a physician and I went through a trauma rotation at OU as a student, at our level 1 trauma center at OU Medical Center, and I know how it should be done. I’ve talked to other ER docs and all said that my c-spine should’ve been cleared, I should’ve gotten a complete spinal CT, an abdominal CT given the abdominal pain s/p MVA, and maybe even a head CT given the force of the accident. She never even did a physical exam except for pointing to my back and asking where it hurt. I don’t even remember seeing a stethoscope. She completely missed my injured shin where I fell trying to crawl out of the vehicle onto the icy ditch. I also had to wait for hours (in pain in the waiting room) before even being taken back to a room, and then was taken to a makeshift room, never hooked to a monitor, not given an IV, etc. No labs were ever done. I was not given pain medication until a long time later, and then it was PO since they never started an IV.

And then the nurse announced an NP was coming in and would be running my case. Oh brother. I was in so much pain and shock I didn’t even think to ask for an MD, and had I done so, that probably would’ve delayed my treatment more.

This NP was grossly inept and her treatment of a complex trauma case was negligent. Mercy shouldn’t be having NPs run trauma cases in their ER. If this ever happens again I will not be going back to Mercy if I can keep from it (sometimes in traumas we have no choice where we go) because I easily could’ve become paralyzed or even worse died.

I asked for as much as I could given that I’m a doc and know some things, and pressed for the CT, but given that I was in so much pain, it was tough, and by the end of it, I was tired of fighting the negligent care and just wanted to go home.

What’s scary is that I’m a physician and knew some of what to ask for…what does the general public do who doesn’t know any better? Suffer as a result of the negligence until something catastrophic happens?  Even at that, I’m a psychiatrist, so trauma/surgery isn’t my specialty, and I really didn’t know fully how negligent the care was until I got home and talked to a few ER physician colleagues of mine.

I had an idea though that I wasn’t getting the best of care, but it’s been awhile since I did trauma/surgery in med school…still even I could tell that so much was being missed.

Simply put, NPs shouldn’t be managing such complex cases, especially without adequate supervision. The fact that I never even saw a physician is scary, given the severity of my case. It’s as if she blew it off and didn’t realize how serious it was. I really don’t think she intentionally tried to do me bad (she seemed nice), but she was just incompetent and way in over her head with my case. NPs are not physicians and don’t have the training to be in that role. God forbid we allow them to practice independently. My story is a great example of what will happen if we do that.

Patrick Horn, M.D.
Medical Director, Psychiatrist
Oklahoma City, OK 73139

Med Student Debt: Veritas vos liberabit.

Guest post by Howard C. Mandel M.D., FACOG:

The electorate will be bombarded in both the 2018 and 2020 election about the $1.4 trillion in education loans outstanding and the 28% currently in default, though a recent Brookings analysis predicts it will increase up to 40% [https://www.brookings.edu/research/the-looming-student-loan-default-crisis-is-worse-than-we-thought/]

The overwhelming majority of these individuals were either sold a bill of goods by for-profit schools or never graduated the public institutions that they enrolled in. Although medical or dental student debt has been shown to impact career choices it rarely results in default.

Did we ever seriously ask ourselves why medical schools are currently so expensive? Where is all that money going? Do the faculties and administrations of our med schools deserve the salaries and benefits they earn?

Are you aware that many medical schools are now paying hospitals to place their students in 3rd and 4th year clinical rotations… what audacity. These hospitals couldn’t exist without Medicare, Medicaid and DSH federal funding——they should be honored to have students on their wards.

Bad policy and Medicare financing of graduate medical education have created the debt crisis for America’s health care workers. There is a major shortage of doctors and nurses and Congress is ignoring treating this because of the economic costs associated with addressing it.

Yet, the inside the beltway crowd has seen a symptom it can campaign on. The right:  Loan default, and made the wrong diagnosis—–people are not educated with the “right major that’s marketable…”  The left: public college should be free for all. Quoting the late community activist, Mimi West, “Free ain’t Cheap…”

National data is biased by the defaults of mostly students that went to extremely large public institutions [not their state flagships] that either dropped out or took 6+ years to graduate. These students probably were not four year college ready and their loans were compounding all the time that they were finding themselves, experimenting with living on their own and maturing into adulthood. The last few decades have seen ever increasing college costs including tuition, fees, room and board.

http://articles.latimes.com/2011/oct/26/local/la-me-college-costs-20111026
 
http://www.learnliberty.org/videos/how-do-we-break-cycle-higher-t/

Society and government leaders pushed an idealistic desire to have every American attain a college education. This goal was encouraged and supported by government employee unions including most public colleges and universities, unionized workers including in many states, professorship. This led to major impacts on state budgets and college costs.

https://object.cato.org/sites/cato.org/files/serials/files/cato-journal/2010/1/cj30n1-5.pdf
 
https://www.heritage.org/jobs-and-labor/report/how-government-unions-affect-state-and-local-finances-empirical-50-state

It also led to inefficiency as well as difficulties for dedicated students to graduate within four years.

https://www.wsj.com/articles/SB10001424052748704657704576149941061124736

 http://www.hup.harvard.edu/catalog.php?isbn=9780674027886

In 2004, Johns Hopkins professors Robert Balfanz and Nettie Legters published an analysis entitled, “Locating the Dropout Crisis. Which High Schools Produce the Nation’s Dropouts? Where are they Located? Who attends Them?”
https://files.eric.ed.gov/fulltext/ED484525.pdf    These schools and other “Factories of Failure” pushed through students who ended up either going to For-Profit Institutions, over crowded Community Colleges or large state institutions.  At the California State Colleges/Universities——-75% of these students need remedial English or Math.  Is it any wonder that the majority never graduate but have accumulated debt?

LAUSD administration claims that “56% of their graduates” are college ready. They are not—-most go to Cal State and need remedial work to even begin introductory college level classes. This 56% is of the only 70% that make it to high school graduation. Unfortunatel, they have previously manipulated data and created sham’s, like their credit recovery program, that inflate the success of students only on paper. As a society we are letting the students in the LA district down.  https://achieve.lausd.net/cms/lib/CA01000043/Centricity/domain/414/documents/Dropout%20and%20Graduation%20Statistics%20for%202010-2011.pdf    

Unless we honestly look at the results we will never develop programs that educate our students to succeed. Of the cohort of students entering high school in LAUSD, only 12.25% actually graduate with either a two year or four year college degree in a total of 6 years after they graduated LAUSD. When looking at the percentage of kids who graduate with “A’s”, only 52% will even graduate any 4 year college within 6 years. Looking at the last year that national comparisons were available, only 1,071 students (4.6%) were in the top quartile of the SAT/ACT.   https://ucla.app.box.com/s/xd8lth2fgy1qdyphmwuj2i7cgyurdwf5

So lets look at who is getting loans in America—-by the numbers, the vast majority are at Community or 2nd tier state colleges. 48% of straight “A” students from LAUSD will not graduate by 6 years and most of the those never graduate. As the school’s tuition’s are not extremely expensive, the overwhelming majority of their loans were used for living expenses for 6 to 8 years and the majority of their debt directly related to inflated costs of living on or near state college campuses, “special fees” to support athletics and recreational centers, bank fees and compounded interest on their balances.

Our philosophical desire to be egalitarian and support college education for all has been manipulated by a public college industrial complex that accepts kids that are not college material at the point they enter. If those students went to community college and lived at home, the billions saved could be given to support smaller but higher quality state colleges and make tuition lower for all who attend. Additionally, extra funds would be left over that could actually provide free housing for academically qualified students that are currently homeless, larger graduate student stipends, medical student scholarships and funding for post docs as well.

Until we truly address the problem, we’ll waste time, money and energy on snake oil that will not cure the disease. The government wants to force physicians to be paid for “performance”, yet the public schools from K through University just want Carte Blanche funding sponsored by taxes or at the college level, loans that often get written off.

Howard C. Mandel M.D., FACOG
Dr. Mandel is an advocate and philanthropist for indigent health care, inner city educational opportunity and a smaller, more efficient government
Los Angeles

Quality of U.S. Medical Residents is In Steady Decline – What Must Be Done!

 

Guest Post From David R Schwartz MD:

As a physician educator practicing in the ICU/hospital environment for >15 years, I have noted a steady decline in the average resident’s knowledge base, clinical skill and efficiency, bedside manner and overall motivation. I am a harsh critic with extremely high standards, though I’ve supervised and been responsible for student/resident/fellow ICU rotations from an educational standpoint throughout.  The vast majority of my colleagues throughout the nation have supported this observation. More telling, daily report from the ICU nurses has chronicled a perennial erosion of their confidence in housestaff!

If true, this poorly documented but worrisome phenomenon combined with the anecdotal, but near universal, acceptance of increasing complexity and acuity of hospitalized patients is a prescription for failure. Explanations are numerous and pervasive.

THE STUDENTS

1) The public regard and economic rewards classically afforded physicians have dwindled dramatically.  While this may select for a less gifted cohort entering our medical schools, I believe the effect on the finished “product” far exceeds any deterioration in raw materials. Our new medical students and young physicians are still gifted.  Continue reading