Patients at Risk

Latest Episodes:

A nurse's journey to becoming a physician: From RN, BSN, MSN, CNS, CCNP to MD-MBA Mar 28, 2021

Show notes

Dr. Toni Manougian has done it all. Starting as an RN diploma graduate, Dr. Manougian obtained her bachelor's in nursing, followed by a master's degree as a clinical nurse specialist and then a degree as a critical care nurse practitioner, become deciding to become a physician.
Dr. Manougian explains the differences in training between the professions and tells aspiring physicians that it's never too late to become a physician if that is your dream.

PhysiciansForPatientProtection.org

Success story: How Mississippi physicians stopped NP scope expansion Mar 21, 2021

Show notes

Jennifer Bryan, MD, a family physician and the chair of the Board of Trustees of the Mississippi State Medical Association, discusses how her state created a coalition to block nurse practitioner scope expansion.

PhysiciansForPatientProtection.org

Nurse practitioner describes gaps in education: "I wasn't fully equipped like I thought I was" Mar 14, 2021

Show notes

Patrice Little DNP discusses limitations in nurse practitioner education and explains why she created a platform to better prepare NP students. Doctor of Nurse Practice Little shares that while she wrote her scholarly project on "full practice authority" for NPs, she realized that many NPs who prioritize patient safety - herself included - don't want independent practice.
Patrice Little DNP's site: https://www.npstudentmagazine.com/

PhysiciansForPatientProtection.org

Why "access" to poor healthcare can be more dangerous than no healthcare at all Mar 07, 2021

Show notes

Many advocates of nonphysician practice argue that we need to allow nurse practitioners and physician assistants to practice independently because of a “provider” shortage. The mantra “access” seems to supersede all other arguments – including concerns over patient safety. But is ‘access’ really all it’s cracked up to be? The answer is no, and here is why. A 2018 Lancet study analyzing 137 countries found that more people die worldwide due to POOR QUALITY care than die due to a lack of access to care (reference below).
Linda Anegawa MD, an internal medicine and obesity specialist, discusses concerns over safety when non-physician practitioners provide healthcare independently without physician supervision, and describes her own story of how a trigger point injection by a nurse practitioner resulted in a punctured lung. Rather than sending her to the emergency department, the nurse practitioner told Anegawa that her shortness of breath was just "procedure anxiety." The truth was that the NP had caused a pneumothorax, or punctured lung, which can be fatal if left untreated.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Lancet article
M.E. Kruk, A.D. Gage, N.T. Joseph, G. Danaei, S. Garcia-Saiso, and J. Salomon. 2018. “ Mortality due to low quality health systems in the Universal Health Coverage era: a systematic analysis of amenable deaths in 137 countries.” The Lancet, 392, 10160, Pp. 2203-2212

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31668-4/fulltext?fbclid=IwAR1uwXVAsi-pOXSTEzJRTyX9nbdLtf8V-cGYMK6BuK_p77lTpNegyaCuUaI
Commentary: https://www.npr.org/sections/goatsandsoda/2018/09/05/644928153/what-kills-5-million-people-a-year-its-not-just-disease?fbclid=IwAR352fPMuZ9Z482Qb6_nFGQ-2bkcovCA3UdARsJDCvdbiHrLvhUasl0VxLo

PhysiciansForPatientProtection.org

Addressing the shortage of bedside nurses Feb 28, 2021

Show notes

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/Suburbanbella
Get 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.2019.00686

PhysiciansForPatientProtection.org

Independent nurse practice in California - what patients and physicians should know Feb 21, 2021

Show notes

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/Suburbanbella
Get the book "Patients at Risk!"

PhysiciansForPatientProtection.org

Patient dies during routine colonoscopy after cost-cutting 'private equity' anesthesia takeover Feb 14, 2021

Show notes

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-sibert
One 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.html

PhysiciansForPatientProtection.org

RN exposes deficiencies in NP education – and the growth of the NP ‘cash’ practice Feb 07, 2021

Show notes

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.org

PhysiciansForPatientProtection.org

RN and former NP student exposes deficiencies in nurse practitioner education Jan 31, 2021

Show notes

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

Standardized exams: what it takes to become a physician - and the failure of the DNP USMLE experiment Jan 25, 2021

Show notes

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

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected