Patients at Risk

Health policy experts note that there is a shortage of registered nurses across the nation and that 11 million nurses are needed to avoid a future shortage.[i] A lack of nurses puts patients at risk, with a 2002 report by the Joint Commission on Accreditation of Healthcare Organizations noting that “inadequate nurse staffing has been a factor in 24 percent of the 1,609 cases involving patient death, injury or permanent loss of function reported since 1997.”[ii] One of the reasons for the bedside nursing shortage is the growth of the nurse practitioner model. It is estimated that the transition of nurses to nurse practitioners has reduced the number of practicing registered nurses by 80,000 nationwide, without a clear plan to replace those positions.[iii] While organizations such as the Institute of Medicine have called for nurses to expand their education to become advanced practice nurses, little emphasis has been placed on how these bedside nurses who go on to become nurse practitioners will be replaced. The COVID19 pandemic has created a particular urgency for more nurses. In fact, so much so that Adventist Healthcare recently posted a call for physicians to be trained to act as nurses. We are joined again today by Dr. Natalie Newman, a California emergency medicine physician, patient advocate, and blogger to discuss the bedside nurse shortage, and the unimaginable call for physicians to work as nurses.Follow Natalie Newman, MD at: https://twitter.com/SuburbanbellaGet the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/[i]Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2020 Mar 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/[ii]Ibid.[iii]  Auerbach DI, Buerhaus PI, Staiger DO. Implications of The Rapid Growth of The Nurse Practitioner Workforce in the US. Health Aff (Millwood). 2020;39(2):273‐279. doi:10.1377/hlthaff.2019.00686PhysiciansForPatientProtection.org

On September 29, 2020, the state of California passed AB 890, a bill allowing nurse practitioners the right to practice without physician supervision. The bill received widespread support from groups that benefit from the use of non-physician practitioners, including hospitals and community health centers. Despite opposition from physicians and other patient advocates, the bill was passed with large margins and was signed into law by Governor Gavin Newsome.Today emergency medicine physician Dr. Natalie Newman joins us to discuss the implications of nurse independent practice in California, one of the largest and most populous states in the Union.  Dr. Newman is not only a practicing physician in California but also an outspoken patient advocate and prolific writer who blogs at Authentic Medicine.com. Follow Natalie Newman MD:  https://twitter.com/SuburbanbellaGet the book "Patients at Risk!" PhysiciansForPatientProtection.org

In April 2020, Beaumont Health, Michigan’s largest healthcare system, made the decision to terminate its established anesthesia group in favor of Texas-based NorthStar Anesthesia, a private equity firm that promised the health system lower staffing costs.  According to reports, more than a dozen physicians and surgeons resigned from the hospital system due to concerns over NorthStar’s reputation.NorthStar’s contract began on January 1 of this year, and on January 25, Eric Starkman, a reporter at Deadline Detroit, reported the death of a patient due to an anesthesia-related complication during one of the most routine medical procedures: a colonoscopy. Did the replacement of Beaumont's anesthesia team by a private equity firm contribute to the death of this patient?  Not only is Beaumont not talking, but according to reports, staff members are being threatened and intimidated into silence.To help us we will discuss how private equity takeovers in medicine may be harming patients, and what you can do to protect yourself, we are joined by Karen Sibert MD, Clinical Professor in the Dept of Anesthesiology and Perioperative Medicine at UCLA, and a past president of the California Society of Anesthesiologists.Dr. Sibert's advice to all patients undergoing anesthesia: "Ask, 'who is my anesthesiologist?' And if the answer is, 'there isn't one,' they should leave."  Further, "if there isn't a physician overseeing your anesthesia care, I can't reassure you that's going to be a safe situation. I think that every patient has a right to know who is taking care of them. There should be complete transparency, and I think physician-led care is the safest care."Get the book!  https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Dr. Karen Sibert's blogs:  https://apennedpoint.com/how-could-a-patient-die-from-anesthesia-for-a-colonoscopy/ https://www.kevinmd.com/blog/post-author/karen-s-sibertOne of our personal favorites, which we cite in our book: https://www.kevinmd.com/blog/2011/11/unsupervised-anesthesia-care-nurse-anesthetist-threat-patient-safety.htmlPhysiciansForPatientProtection.org

In our last episode we discussed the rapid growth of nurse practitioner training programs and some of the challenges this has caused in ensuring that nurse practitioner graduates receive adequate clinical training to care for patients. Today we continue to explore concerns about nurse practitioner quality of education, as well as a new trend for nurse practitioners to seek work in cash-pay type practices, including opening medi-spas, infusion centers, medical marijuana clinics, and so on.To help us explore these issues, we are joined again by Rayne Thoman, a registered nurse and former NP student who works to expose unethical nurse practitioner training and practice. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Physicians, join us at physiciansforpatientprotection.orgPhysiciansForPatientProtection.org

There are over 400 nurse practitioner schools in the United States, with nearly HALF of these programs promoting online training—ranging from 50-100% of required academic training sessions. Some of these programs offer accelerated training, allowing students to become an NP in as little as 2 years, others offer flexible schedules with part-time programs allowing students to work full-time while they attend school. In contrast, there are just 179 medical schools producing physicians in the United States.  None of them are online, and there are no part-time medical schools.Why has there been such a proliferation of nursing schools, and with such a huge number and variability of program types, who are ensuring that these programs are producing qualified medical clinicians?To help us explore these issues, we are joined by Rayne Thoman, a registered nurse who left nurse practitioner school when she discovered serious problems in the educational standards. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

The pathway to becoming a licensed physician in the United States requires nine to eleven years of formal education, and all physicians are required to pass a series of three high stakes standardized examinations called the United States Medical Licensing Examination (USMLE) before they can be licensed as to practice medicine. Most physicians also go on to become board-certified in their specialty field, which requires an additional examination following their residency or fellowship training.  Compared to physicians, nurse practitioners and physician assistants have a far shorter course of training, and both are required to pass one standardized examination to be licensed to practice.  In 2008, the National Board of Medical Examiners offered down a simpler version of the USMLE Step 3, an examination all physicians take to receive a medical license. The pass rates for DNP candidates ranged from 33%-70%, and the experiment was discontinued in 2014 due to "low utilization."Roy Stoller DO, an otolaryngologist and board examiner, joins Rebekah Bernard MD and Niran Al-Agba MD in a discussion of the differences between the exams that medical doctors and nurse practitioners and physicians assistants take.  Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

Psychiatrist Torie Shatzmiller Sepah MD discusses her experiences as a chief psychiatrist at the California Department of Corrections, and her role in the "Golding Report," a whistleblower report by Michael Golding MD that alleges improper psychiatric care of inmates. Complete report here:  https://www.scribd.com/document/392536943/Dr-Michael-Golding-California-prison-report-on-mental-healthcareThis episode contains brief graphic descriptions of inmate harm as well as physician suicide. If you are having any thoughts of self-harm, please call your physician or the suicide prevention lifeline immediately. Physicians, medical students, and resident/ fellow physicians may also obtain free and confidential help through the Physician Support Line, a service offered by volunteer psychiatrists 7 days per week.  Call: 1 (888) 409-0141 or physiciansupportline.com to learn more.Get the Patients at Risk book!  https://www.amazon.com/gp/product/B08M9YJQR3/Learn more about Physicians for Patient Protection: PhysiciansforPatientProtection.orgPhysiciansForPatientProtection.org

Dr. Torie Shatzmiller Sepah, a practicing psychiatrist, discusses the differences between psychologists and psychiatrists, and the increasing trend of allowing psychologists to prescribe medications.Get the book Patients at Risk: https://www.amazon.com/gp/product/B08M9YJQR3/ref=dbs_a_def_rwt_bibl_vppi_i0To learn more about cognitive behavioral therapy, Dr. Sepah recommends the book "Thoughts and Feelings" - https://www.amazon.com/Thoughts-Feelings-Taking-Control-Moods/dp/1684035481/Physicians: Join Physicians for Patient Protection - physiciansforpatientprotection.orgPhysiciansForPatientProtection.org

Corinthia Davidson-French shares the story of her son's missed diagnosis of aplastic anemia after multiple visits to an FNP at the local clinic. We also discuss racial disparities in the healthcare system, and what patients can do to advocate for their own medical care.Learn more about becoming a bone marrow donor at: BeTheMatch.org.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Citations:Goldberg GA, Jolly DM, Hosek S, Chu DS. Physician's extenders' performance in Air Force clinics. Med Care. 1981;19(9):951‐965. doi:10.1097/00005650-198109000-00007Morrison F, Shubina M, Goldberg SI, Turchin A. Performance of primary care physicians and other providers on key process measures in the treatment of diabetes. Diabetes Care. 2013;36(5):1147‐1152. doi:10.2337/dc12-1382 Kurtzman ET, Barnow BS. A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers. Med Care. 2017;55(6):615‐622. doi:10.1097/MLR.0000000000000689 PhysiciansForPatientProtection.org

Gerald "Jay" Baltz, a psychiatric mental health nurse practitioner who is being investigated by the California Board of Nursing for an inappropriate sexual relationship with a patient who later took her own life, received his training at an online program that required a minimum of 500 clinical hours of experience for graduation.  Baltz continues to provide psychiatry care to patients in California and Washington state, and since receiving a doctorate degree in nursing, he now advertises as "Doctor" Jay Baltz, DNP. We are joined by psychiatrist Dr. Natasha Cervantes to discuss the differences in training between psychiatrists and psychiatric nurse practitioners, and why the difference in care can be a matter of life or death.If you are someone you know is having thoughts of self-harm, help is available. Contact your physician immediately, or call the Suicide Prevention Lifeline for help at 800-273-8255.Learn more about this issue - get the book Patients at Risk, available at Amazon and Barnes and Noble. https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org