1.14.2020

Lending my Support: Nurse Practitioner Diploma Mills Not the Answer to Physician Shortage

As I watch the entire healthcare system undergoing huge changes since about 2011, there are a lot of hot issues going on.  This morning as I stumbled upon this site and this article.  It makes a lot of valid points.

Physician Voices for Patients and for Our Profession

Physicians for Patient Protection is a grassroots organization of practicing and retired physicians, residents, medical students, and assistant physicians (a new designation for physicians who have finished medical school but haven’t yet matched in a residency).

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Source:  https://www.physiciansforpatientprotection.org/nurse-practitioner-diploma-mills-not-the-answer-to-physician-shortage/?

This is just part of a good article I read this morning and wanted to share...

Nurse Practitioner Diploma Mills Not the Answer to Physician Shortage



"Consequence: NP Diploma Mills


The second dangerous trend in promoting nurse practitioner autonomy is the recent tremendous growth of diploma mills, programs that “graduate” minimally trained nurses who are nowhere near ready to care for patients independently.

I’m referring to the dozens of direct to DNP programs, many of which boast a 100% acceptance rate.  I’m talking about programs that promote “as little as fifteen months from MSN to DNP,” or “use work hours to apply to your clinical training.”  There are multiple accelerated programs that allow students who have never even worked one hour as a nurse to become a nurse practitioner, and also direct entry programs that allow students with a non-nursing bachelor’s degree to become a registered nurse and a nurse practitioner “seamlessly.”

Once in attendance, coursework for these nursing programs may be 100% online.  And while a certain number of clinical experience hours are required, they are often on the honor system and often involve simply shadowing a doctor or nurse, many of whom the students have to find themselves.  There are simply not enough clinical preceptors to train nurse practitioner students, and the number of preceptors can only be expected to decline as the number of students seeking training increases.

Consequences: Poor Practice Patterns


And unfortunately, this lower quality of clinical experience is beginning to become apparent. While early studies showed that NPs working under physician supervision were able to produce similar outcomes in the management of already diagnosed chronic conditions, these NPs were mostly trained at brick and mortar schools, with a high level of clinical experience in nursing before advancing their career.

Newer studies are demonstrating that removing standardized curriculum and physician supervision from nurse practitioner training and practice is impacting the quality of patient care, including poorer quality referrals to specialists compared to primary care physicians, more unnecessary skin biopsies than physicians, increased diagnostic imaging, increased prescriptions including increased antibiotic prescribing and higher opioid prescribing shown in the states of Connecticut and New Hampshire.

Payouts for malpractice claims against NPs are also on the rise, as are claims for the improper prescribing and management of controlled substances.  As training programs continue to churn out NPs at a rate of 23,000 per year, compared to about 19,000 physicians graduating from medical school per year, these trends are likely to continue.

NPs SHOULD Care


If you are a NP reading this, you should be outraged. Your profession is being diluted and abused by your leadership and your teaching institutions. Ultimately, the nurse-as-doctor agenda will backfire as the market becomes saturated with diploma mill grads, and as patients realize that their lives are being sold to the lowest bidder to hospital and organizations who employ new nurse grads ill-prepared to care for them.

Physicians Should Care


If you are a physician, you should be outraged. Your years of work and sacrifice are being alarmingly devalued as you are replaced by an online graduate.  There is no online medical school. There is no “honor system” in med school – no one graduates without passing a rigorous evaluation process. There are no shortcuts to the 20,000 hours minimum of clinical experience that physicians receive during training. And yet you will rarely meet a physician with complete confidence, because even with all this training, most realize that there is so much they don’t know.

Politicians Should Care


NPs are Not Filling a Void in Primary Care

If you are a politician, you should be outraged.  And worried. Because your constituents will see that you have fallen for the lobbyist lines.  NPs lobby that they will enter primary care practice to ease the shortage of physicians, but this has proven to be untrue.  CMS data from 2012 showed that NPs are moving more and more into subspecialty practice, where they are practicing independently having received little to no supervised practice in that specialty.  Because unlike physicians, who must complete a separate residency of at least three years to change specialty, NPs can jump from one field to another without any additional formal training.


The Rural Access Fallacy


You have also fallen for the hype that NPs will provide care in rural areas, where physicians supposedly “won’t” go.  Also, untrue. In Arizona, where NPs have been unsupervised since 2001, only 11% of all non-physicians (NPs, PAs, CNMs) work in rural areas, and serve only 15% of Arizona’s rural population.


The Financial Advantage Fallacy


And if you have believed the line that NPs save money, well, you may not have seen that the goal of the American Association of Nurse Practitioners is pay parity1 – that NPs be paid the same as physicians – a goal which was achieved legislatively in Oregon in 2013.  Not to mention that NPs may cost the system more, with a rigorous ten-year study showing that unsupervised CRNA practice in rural areas was more expensive than hiring physician anesthesiologists.


Patients Should Care


If you are a patient, you should be outraged. And scared. But also, hopeful. Because physicians like me really do care about you.  I am part of a group called Physicians for Patient Protection (PPP).  We recently traveled to Washington DC on our own dime to talk to legislators about our concerns for the future.

For most of us, it’s not about the money. If I wanted to be rich, I wouldn’t have chosen Family Medicine. I wouldn’t have worked in an underserved area for years. And I wouldn’t have opened a low cost Direct Primary Care practice.
It’s also not about a turf war. There are many, many jobs out there for good docs.
It really and truly is about patient safety. We worry about our own health and that of our family. We want the best care for our future too."





 Be sure to check out the SOURCE link above for the whole article!