Patients at Risk

Latest Episodes:

Will an NP or PA perform your next colonoscopy? Aug 22, 2022

Show notes

Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer.
Colorectal surgeon Amer Alame MD discusses the flaws in a 2020 Johns Hopkins study advocating for the use of NPs to perform colonoscopies.
Riegert M, Nandwani M, Thul B, Chiu AC, Mathews SC, Khashab MA, Kalloo AN. Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients. Endosc Int Open. 2020 Oct;8(10):E1423-E1428. doi: 10.1055/a-1221-4546. Epub 2020 Sep 22. PMID: 33015346; PMCID: PMC7508647.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/

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Physician, Own Thyself: Taking Back Professional Control Jul 18, 2022

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Tired of being owned by corporations, but don't want to open your own practice? Stephanie Freeman, MD, a critical care physician and entrepreneur, teaches physicians how to become self-employed through contract work and locums.
Learn more at DrStephanieICU.com
http://www.freelocumstraining.com for free online locums training.
National Association of Locums and Independent Physicians
http://www.na-lip.com

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Nursing research leaders: NPs should not work alone in the ER Jul 05, 2022

Show notes

In Jan 2022, the Journal of Nursing Regulation published an article entitled:

Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency Departments

The summary: “Due to the variability in educational preparation, NPs should not perform independent unsupervised care in the ED regardless of state law or hospital regulations.”

This unequivocal statement contradicts the rhetoric of NP leadership which insists that NPs should be allowed to practice virtually anywhere and everywhere without supervision. Today I’m joined by family physician Christopher Garofalo, and radiologist and PPP board member Phil Shaffer to discuss this important paper.

PhysiciansForPatientProtection.org

Point of view: Let NPs and PAs practice independently - but hold them to the same standard as a physician Jun 20, 2022

Show notes

Attorney and emergency medicine physician William P. Sullivan believes that nonphysician practitioners should practice independently, but be held to the same medical standard as physicians since NP/PA leaders argue that there is "no difference in the practices and outcomes between physicians and advanced practice providers."
Dr. Sullivan joins us to discuss his article on this issue - https://sullivanlegal.us/nurse-practitioner-and-physician-assistant-standard-of-care/
Get the book! https://www.amazon.com/dp/B08M9YJQR3/

PhysiciansForPatientProtection.org

The headlines don't always match the data: an example of egregious methodology in NP literature Jun 06, 2022

Show notes

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/

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The secret to hiring and retaining good doctors (and why hospital administrators don't want to hear it) May 23, 2022

Show notes

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

Women physicians on scope of practice (part 2) May 09, 2022

Show notes

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

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No shortcuts in medicine: why women physicians are fired up about scope of practice (Part 1) Apr 25, 2022

Show notes

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

Is it time for an NP/PA 'Flexner Report?' Part 2 Apr 11, 2022

Show notes

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.

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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.

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PhysiciansForPatientProtection.org

Is it time for an NP/PA Flexner Report? Part 1 Apr 04, 2022

Show notes

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

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