Patients at Risk

In several previous podcasts, you have heard us refer to research studies that claim to show that nurse practitioner care is just as good or better than that provided by physicians. We’ve shown that in many of these cases, the study authors are using flawed methodology or failing to disclose important information, like nurse practitioners working under physician supervision.  Today we invite you to attend Patients at Risk’s first “Journal Club” session as we dissect a study that claims to show that having more nurse practitioners working in hospitals improves patient care, and the methodology used by the authors is just about one of the most egregious examples we have ever seen. To help explain this study, we are joined by two physician experts, Dr. Dylan Golomb and Dr. Marsha Haley.  THE BOTTOM LINE: The study authors claim that “having more NPs in hospitals has favorable effects...and adds value to labor resources” - but the methodology they use involves asking nurses to ESTIMATE the number of NPs that work in their hospitals - without any validation that this estimate is accurate.Aiken LH, Sloane DM, Brom HM, Todd BA, Barnes H, Cimiotti JP, Cunningham RS, McHugh MD. Value of Nurse Practitioner Inpatient Hospital Staffing. Med Care. 2021 Oct 1;59(10):857-863. doi: 10.1097/MLR.0000000000001628. PMID: 34432769; PMCID: PMC8446318.GET THE BOOK:  https://www.amazon.com/dp/B08M9YJQR3/PhysiciansForPatientProtection.org

Douglas Farrago MD discusses why '9 out of 10 administrators' absolutely hate his new book, The Hospital Guide to Physician Retention: Why Creating A Physician-Friendly Environment Is Critical For Your Organization’s Success. Dr. Farrago has been fighting to improve the state of medicine for decades, authoring books on direct care and pointing out the fallacies in health care at his blog, AuthenticMedicine.com. His newest book, The Hospital Guide to Physician Retention is focused on improving the work environment of physicians.  "When doctors feel valued and have meaningful relationships with their patients and co-workers, they are much less likely to leave," says Farrago, which saves hospitals up to $1 million per physician. "Happy doctors stay, and happy doctors help recruit other doctors, leading to happier and more satisfied patients."So, why did so many administrators hate this book?   PhysiciansForPatientProtection.org

Sonal Patel MD and Jou Jou Hanna MD discuss the difficult choices that women make to become physicians, and why that training matters.PhysiciansForPatientProtection.org

One topic that gets women physicians fired up like no other is a discussion of gender issues in medicine. While medical school classes are currently made up of about 50% women, women physicians are still a significant minority in medical practice today, and women doctors face serious inequities due to their gender. One of the biggest challenges that women must face is the decision of if or when to have children, because of the intense and lengthy educational training process that doctors must complete.A recent post from a nurse practitioner student who reported feeling guilty about being away from her children while on clinical rotations caused controversy among women physicians. Many women physicians noted that the number of clinical hours that the nurse practitioner student was complaining about was just a fraction of what they have had to go through while other women physicians argued that no woman clinician should have to feel guilt about balancing child-raising with education. Dr. Sonal Patel and Dr JouJou Hanna join us to discuss the nuances of this issue.PhysiciansForPatientProtection.org

Part 2 of our discussion with John Lafferty MD regarding the need for Flexner-style reform for NP and PA programs. Dr. Lafferty describes his experiences training PA students.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Thanks to our sponsor:Old Pueblo Anesthesia (OPA) is a physician-owned and operated practice that has served the southern Arizona community for over 40 years. They are committed to delivering anesthetic care exclusively by physicians and annually provide over 20,000 anesthetics to patients undergoing surgery, labor and delivery, pain management, and diagnostic procedures.  OPA provides anesthetic services at multiple outpatient surgery centers and is the exclusive provider of anesthesia services at TMC Healthcare, a large regional health care system in Tucson, Arizona.  Their cardiac anesthesiologists cover a robust open-heart program and are also intimately involved in the operation of the largest minimally invasive structural heart program in Southern Arizona.  TMC has a level III NICU and OPA’s Labor and Delivery team provides 24/7 in-house coverage for over 5000 deliveries per year.Outside the operating room, they provide anesthesia services for adults and children in the GI suite, MRI/CT, and interventional radiology.OPA’s leadership and recruiting team would love to discuss professional employment opportunities for anesthesiologists with the desire to live and work in a part of the country with incredible weather, year-round outdoor activities and a very affordable cost of living. They currently have openings for both partnership track positions as well as several employee/non call positions. OPA is seeking pediatric fellowship-trained anesthesiologists, cardiac fellowship-trained anesthesiologists and has positions available for non-fellowship trained anesthesiologists as well. There are positions available with no hearts or OB if you do not want to work in those areas.For more information, please contact Mark McClain, M.D., @ Mark.McClain@opatucson.com or Jim Rodriguez, CEO @ jrodriguez@opatucson.com or visit their website at www.opatucson.comPhysiciansForPatientProtection.org

Many of our podcasts have focused on concerns about the deterioration of nurse practitioner training, with an increase in for-profit schools that compete fiercely for student tuition dollars. These programs often boast 100% acceptance rates -in other words, anyone who applies is accepted. Students who attend programs like these complain about sub-par education including open-book tests that leave graduates inadequately prepared to care for patients. The rise of these diploma mills has led many to call for reforms to the NP educational process. What many people do not realize is that the medical profession also faced serious reforms in its educational process following the release of the Flexner report which outlined problems in the training of physicians back in 1910. Today I am joined by Dr. John Lafferty to discuss the Flexner report and the importance of standardizing education for medical professionals.  Dr. Lafferty is an obstetrician-gynecologist with a special interest in the history of medical education. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/We highly recommend Physician Outlook magazine - a magazine for physicians and patients, created by physicians. Learn more at PhysicianOutlook.com PhysiciansForPatientProtection.org

One of the strategic goals of the American Association of Nurse Practitioners listed on their website (now behind a paywall) is for nurse practitioners to achieve pay parity:  to be paid the same as physicians. Oregon became the first state to require that insurance companies pay nurse practitioners the same as physicians and now proposed legislation would do the same in Washington state. To discuss the implications of pay parity in Washington and elsewhere, we are also joined by the past president of the Washington state radiological society, Dr. Pooja Voria. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

As nonphysician practitioners increasingly provide more patient care, experts note a commensurate increase in medical malpractice claims. Today we welcome medicolegal adviser Bob Pegritz, the co-author of ‘Hospital Confidential,’ an expose of medical malpractice cases.  As Bob wrote me, "I have worked in the medical/legal community for 32 years. Before that, I was a surgical PA. As a medical/legal consultant, I have seen a trend over the past 5 years of more PAs crossing my desk for merit review in potential medical malpractice cases. And I think that the number of mid-level healthcare practitioners will do nothing but increase if things don't change."Get Bob's book!  https://www.amazon.com/Hospital-Confidential-Bob-Pegritz/dp/B09LGTSXFV/For more information, visit PatientsatRisk.comGet the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

As our listeners already know by now, to be licensed to practice medicine, physicians in most states must complete a minimum of three years of postgraduate medical education, called residency training. Each specialty offers its own residency program, but all must follow specific, standardized criteria created by the ACGME—the American College of Graduate Medical Education. If programs fail to meet these criteria, they will not be credentialed by the ACGME, and graduates will not be licensed to practice medicine. Recently, the ACGME announced revisions to residency training for Family Physicians, and I’m privileged to be joined today by two family physicians to discuss the proposed changes. Dr. Mark Huntington is the director of the Center for Family Medicine at the South Dakota Sanford School of Medicine, and Dr. Rishi Patel is a family physician and a relatively recent graduate of residency training. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164PhysiciansForPatientProtection.org

Almost every field of medicine today involves some type of nonphysician practitioner, whose role was originally created to help physicians see patients more efficiently. The specialty of radiology is no exception, and radiologists often work with NPs, PAs, and another type of extender called a radiology assistant (RA).  In part 2,  I am joined by two radiologists to discuss the use of nonphysicians in radiology and concerns that an increased push for these extenders may negatively impact patient care.Phil Shaffer MD is a recently retired radiologist and frequent guest of our show. He is also a board member of PPP. Sharon D’Souza MD MPH is a radiologist in private practice.PhysiciansForPatientProtection.org