Patients at Risk

Rebekah Bernard MD and Niran Al-Agba MD

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. read less

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JOURNAL CLUB: Article claims that NPs, PCPs have same rate of inappropriate prescribing to seniors

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 PhysiciansThe 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/m23-0827Get the books! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/PhysiciansForPatientProtection.org

Episodes

JOURNAL CLUB: Article claims that NPs, PCPs have same rate of inappropriate prescribing to seniors

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 PhysiciansThe 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/m23-0827Get 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?

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)

"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-thePhysiciansForPatientProtection.orgPhysiciansForPatientProtection.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)

"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-thePhysiciansForPatientProtection.orgPhysiciansForPatientProtection.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)

"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-thePhysiciansForPatientProtection.org

The Assistant Physician (AP) - A pathway to independent practice?

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/1627344438https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

BONUS EPISODE: AZ State Rep and ER physician Dr. Amish Shah discusses his run for U.S. Congress

BONUS EPISODE: AZ State Rep and ER physician Dr. Amish Shah discusses his run for U.S. Congress

Emergency physician Dr. Amish Shah has served the Arizona State House for the last five years and is now running for U.S. Congress. In this special bonus episode, Dr. Shah explains why he entered into politics, the work he has done to support the practice of medicine, and why physicians should donate to his campaign.Learn more / contribute to Dr. Shah's campaign here: https://www.amishforarizona.com/ Meet Dr. Shah at his fundraiser at the Take Medicine Back meeting February 9, 2024 in Palm Springs https://www.takemedicineback.org/PhysiciansForPatientProtection.org

Physician legislator and creator of 'assistant physician' role in Missouri discusses steps to improve physician shortages

Physician legislator and creator of 'assistant physician' role in Missouri discusses steps to improve physician shortages

There is no doubt that America is facing a physician shortage, due in large part to a lack of residency positions, the mandatory 1-3 years that medical school graduates must complete to receive a license to practice medicine. Today we are talking about a proposed solution to this problem—a new professional designation for unmatched medical school graduates called the “Assistant Physician” (AP). I am joined by Dr. Keith Frederick, the originator of the first legislation to create the AP role, and Dr. Liz Troilo, who worked as an AP before becoming a board-certified family physician. Learn more about physician-led care - get the book IMPOSTER DOCTORS.PhysiciansForPatientProtection.org

Physicians fight to prevent more patient deaths from 'wellness' treatments at medspas

Physicians fight to prevent more patient deaths from 'wellness' treatments at medspas

In July 2023, 47 year old Jenifer Cleveland, a mother of four, died after receiving treatments at a Texas medispa. We reported on this tragic story in a podcast with plastic surgeon Alina Sholar (https://www.buzzsprout.com/1475923/13329411-when-wellness-turns-deadly-patient-dies-during-npp-medspa-visit.mp3?download=true). Today, we are discussing the aftermath of this case and efforts by Texas physicians to ensure that no more patients die from ‘wellness’ treatments. Dr. Mary Kelly Green is an ophthalmologist and founding member of Texas 400, and advocacy group protection fighting to protect patients.PatientsAtRisk.comPhysiciansForPatientProtection.org

NP malpractice settlements on the rise, especially for NP-owned practices

NP malpractice settlements on the rise, especially for NP-owned practices

Malpractice insurance company CNA, along with Nurses Service Organization (NSO) has been providing malpractice coverage for nurse practitioners across the country in a variety of practice settings for the last 30 years. The organization released its first report on NP malpractice claims in 2005, and recently released its 5th report analyzing data between 2017 and 2022. Dr. Kevin Zhang joins me to discuss the findings of this report including:Increase in average total claims for NPsHighest average claim among NPs covered through an NP-office practiceMost frequent claim: Failure to diagnosehttps://www.nso.com/Learning/Artifacts/Claim-Reports/Nurse-Practitioner-Claim-Report-5th-Edition Get the new book! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438PhysiciansForPatientProtection.org

Wisconsin NP legislator makes unprofessional comments during testimony on vetoed bill

Wisconsin NP legislator makes unprofessional comments during testimony on vetoed bill

Nurse practitioner and Wisconsin Senator Rachael Cabral-Guevara jokes about 'missing' lobbyist Mark Grapentine's IV... and using the largest bore needle to try again. Bill co-sponsor Rep. Barbara Dittrich responds by pulling her name off the legislation.Get the books!https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438PhysiciansForPatientProtection.org

The Medical Ethics of IV hydration ‘bars’

The Medical Ethics of IV hydration ‘bars’

There has been a dramatic rise in the number of clinics offering intravenous infusions of fluids and vitamins to treat an array of conditions and for a supposed wellness benefit. But do these treatments actually work? To discuss the risks and benefits of IV infusions outside of a traditional medical setting I am joined by nephrologist Dr. Christin Giordano. Get the new book! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438PhysiciansForPatientProtection.org

Esteemed physician organization American College of Cardiology selects nurse as new president

Esteemed physician organization American College of Cardiology selects nurse as new president

Interventional cardiologist Dan Sraow, MD, FACC discusses the election of a nurse rather than a physician to lead the American College of Cardiology (ACC), as well as the risks of non-physicians performing cardiac interventions.PhysiciansForPatientProtection.org

Louisiana doctors succeed at passing graduate physician bill

Louisiana doctors succeed at passing graduate physician bill

There is no doubt that America is facing a physician shortage, due in large part to a lack of residency positions, the mandatory 1-3 years that medical school graduates must complete to receive a license to practice medicine. To alleviate this shortage, some states have a new professional designation for unmatched medical school graduates called 'assistant physician' or 'graduate physician.' Representatives for Louisiana Physicians for Patients discuss their role in passing legislation to allow graduate physicians the opportunity to work under the supervision of a licensed physician in the state.PhysiciansForPatientProtection.org

Louisiana physicians hire lobbyist and defeat NP independence bill

Louisiana physicians hire lobbyist and defeat NP independence bill

Louisiana physicians discuss their successful effort to block scope of practice expansion in the state.PhysiciansForPatientProtection.org

Bioethicist weighs in on use of the term 'doctor' by nonphysicians

Bioethicist weighs in on use of the term 'doctor' by nonphysicians

In 2023, three nurse practitioners sued the state of California for the right to call themselves 'doctors' in a clinical setting. Bioethicist Arthur L. Caplan, PhD, discusses the ethics of titles in healthcare.Dr. Caplan's article - https://www.medscape.com/viewarticle/994536Get the book Patients at Risk and Imposter Doctors!PhysiciansForPatientProtection.org

Patient asks for OB physician during pregnancy and delivery, told 'no'

Patient asks for OB physician during pregnancy and delivery, told 'no'

At 39 years old, Hasina Hafiz wanted a physician to oversee her pregnancy and delivery. However, the only clinic in the area that accepted her insurance refused, allowing only CNM/ WHNP care. Retired OB/GYN John Lafferty, MD discusses complications that can occur during pregnancy and delivery, and why team-based care should always be led by a physician.PhysiciansForPatientProtection.org

Noncompete contract restricts rural patient access to physician care

Noncompete contract restricts rural patient access to physician care

Jacqui O'Kane, DO was fulfilling the promise of Family Medicine, providing expert physician care to rural residents of Georgia. Burned out from overwork and support staff challenges, she decided to leave hospital employment. But instead of allowing her to open her own direct primary care practice, the hospital enforced a 50-mile radius noncompete contract, limiting patient access to care. Listen in on our discussion of noncompete contracts and why some physicians are leaving employed practice in favor of self-ownership.For tips and tricks on surviving the fee-for-service world, check out my book, How To Be a Rock Star Doctor.Docs, join our fight for physician-led care and truth and transparency among healthcare practitioners - Physicians for Patient Protection.PhysiciansForPatientProtection.org

Physician discusses why she will no longer train or supervise NPPs

Physician discusses why she will no longer train or supervise NPPs

Sara O'Heron, MD discusses changes in the education and training of NPs and PAs over her 35-year career.Learn more at PatientsAtRisk.comGet the new book, Imposter Doctors, available in paperback, eBook and Audible: https://www.amazon.com/Imposter-Doctors-Patients-at-Risk-ebook/dp/B0C4J3P3Z1/PhysiciansForPatientProtection.org

When 'wellness' turns deadly: Patient dies during NPP medspa visit

When 'wellness' turns deadly: Patient dies during NPP medspa visit

Plastic surgeon Alina Sholar, MD discusses the risks and dangers associated with non-physician supervised medspa medical procedures. Get the new book! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/Join PPP: PhysiciansForPatientProtection.orgPhysiciansForPatientProtection.org