Disincentivize the mostly ineffective practice of throwing brain dulling meds at all psych problems, if they worked, depression would be down, but its up, after a couple of decades of over-using them obnoxiously. (see Peter Breggin’s work) But its super profitable to write a script and kick the person out the door. …a minute later. One reason a provider will write an RX for mild anxiety, grief and sadness is it pays multiple times more than talking with the person. CMS pays medical providers a small fee to do psychotherapy, but hardly anyone does it because of the lack of good money. They make good therapists with a little training in CBT and supportive therapy. Pay them well and they will do it.
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Medications are there to support the person. Therapy is key, but many people prefer a quick fix unfortunately. Just look at ozempic. People don’t want to eat healthy and exercise. Other conditions such as schizophrenia or bipolar mania are more responsive to medications.
It would help if they stopped allow NPs and PAs to diagnose indiscriminately often leaving people with a misdiagnosis they carry for the rest of their life which is costly.
And prescribers will bill 99214 + 90833 which only takes 16 minutes and nets more than a 90837 which is unacceptable. In this instance it makes an LOT. Even worse, NPs and PAs with no training in therapy (bad training in diagnosing and prescribing) bill the therapy add on code to make more $. It’s legalized fraud and the loop hole needs to be closed.
These changes will cut costs by reducing inappropriate prescribing and billing for something they haven’t been trained in.
Never refer someone to a place that employs a lot of NPs and PAs, they’re just out to make a buck at the expense of YOUR health. Just Check out r/noctor
Remarkable, Jane, how you have a lot of anger and feel you need to trash PAs and NP’s. Outcomes for patients are the same for PA, NP and MD, so they must be trained as well. Now that you mention it, PA’s and NP’s are a good solution to the shortage of HCP’s. Same outcomes, lower cost. No brainer.
Outrage because it’s literally killing a lot of people. NPs in particular are terrible, they’re just money hungry. It’s obvious they just want to take a short cut to practicing medicine and dgaf about actual quality care. Outcomes are only the “same” in NP and PA journals with studies designed to produce a certain outcome, ex: NPs manage UTIs, URIs and other simple cases vs MDs manage complex patients with DKAs , decomensated HF etc and then whammm NP>better because they have less hospitalizations.
I can link you dozens of studies from actual REPUTABLE journals and organizations from JAMA, lancet, AMA showing NPs and PAs order more unnecessary antibiotics, narcotics, opioids, benzos, labs, imaging, poor quality specialty referrals, unnecessary costly biopsies, etc meaning they in fact cost the patient more, bring more business to the hospital system, and they get to pay them less…all the while the patient often thinks they’re being seen by a doctor.
Most of these NPs diploma mills have a near 100% acceptance rate with minimal experience requirements.
The public is waking up, r/noctor is growing.
You even find NPs and PAs who decline to be seen by anyone other than an MD it’s ironic.
NPs and PAs were created to help with the shortage in rural locations and other locations without access to providers. The problem is most aren’t living up to their word and practicing in those areas. Many aren’t accepting Medicare or Medicaid because it’s all about the money, not the patient.
PA’s are trained more like MD’s, with cadavers and surgery training, and may be better, but there are many studies showing the same outcomes for all prescribers, here is one from pubmed. Most PA’s are in specialties and see every kind of problem, from transplant to heart failure and stroke and kidney failure, hospital medicine, emergency and codes. PA’s and NP’s are also the backbone of primary care, as in see the most patients, and most patients choose to see them over MD because they seem to take more interest in the person and take more time with them asking more questions to get a better history. Maybe change the system so the MD’s do not get abused in intership and residency and so they are nicer and more interested in people/ healing the whole person like PA’a and NP’s. Saying you know who NP’s/PA’s want to see, is there any data about that you can cite?
Jane please reveal your real name. Are you with the AMA which has a campaign to eliminate all competition? If so you are damaging healthcare. Here is a letter to AMA from PA’s:
September 3, 2024
Bruce A. Scott, MD
President
American Medical Association
330 N Wabash Ave
Chicago, IL 60611-5885
Dear President Scott,
On behalf of the American Academy of Physician Associates (AAPA), we are writing to express our
growing concern over the American Medical Association’s (AMA) lack of response to our request for a
meeting to discuss the impact of AMA’s disparaging rhetoric targeted at the physician associate ¶
profession. As outlined in our previous letter, we set a target date for your organization to respond to our
request for a meeting, underscoring the urgency of this matter. Regrettably, this date has now passed
without a response from the AMA.
AAPA stands firm in our intention to collaborate with the AMA on a better path forward. While our two
organizations may not see eye to eye on every policy, we trust that there are areas of common ground.
However, the continued silence from the AMA raises concerns about your commitment to collaboration
and finding solutions to strengthen America’s healthcare workforce and improve patient care. We urge
the AMA to reconsider its stance and join us in addressing the pressing needs of today’s healthcare
environment, rather than maintaining outdated practices that no longer serve the best interests of
patients.
New Research on the Harmful Impact of the AMA’s Disparagement of PAs
Since our previous letter, AAPA has engaged with PAs from across the country to gauge their
perspectives on the impact of the AMA’s “scope creep” campaign. The results of the survey, which reflect
the opinions of more than 4,900 PAs, are deeply troubling:
• 96% say it has had a negative impact on addressing healthcare workforce shortages.
• 95.2% believe it has negatively impacted efforts to expand access to care for patients.
• 90.4% of PAs report that the campaign has negatively impacted the healthcare system.
• 81.0% report the campaign has had a negative or very negative effect on their ability to
provide care.
• 81.7% reported a negative or very negative impact of the campaign on their relationships with
patients.
• 91.9% assert it has negatively impacted patients’ trust in the U.S. healthcare system.
• 89.5% believe the AMA’s scope creep campaign has negatively impacted patients’
understanding of PA qualifications to provide care.
2
It is clear from these findings that the AMA’s intentional use of misleading information about PAs’ ability
to provide safe, high-quality care has serious consequences for our healthcare system and patients.
When patients are misled or misinformed about the qualifications and expertise of PAs, they may delay
seeking care when a highly-trained and qualified PA is available and able to treat them. Patients deserve
to have full confidence in the qualifications and expertise of all healthcare providers. Given that PAs treat
and connect with patients often during some of their most vulnerable moments, it is our responsibility to
foster trust in PAs to ensure their needs are being met with quality care.
Thousands of PAs Speak Out Against AMA-Backed Rhetoric
Additionally, this month, over 8,000 PAs signed a letter expressing their urgent concerns about the
AMA’s approach (letter enclosed).
“The AMA’s rhetoric misrepresents the contributions of the nation’s 178,000 PAs and does not reflect the
views of many physicians. The most effective healthcare for people occurs when clinicians work together
as a team, and many of our physician colleagues recognize and value the critical role PAs play in patient
care and believe in the power of team-based care over preserving outdated hierarchies,” the signatories
wrote.
The signatures on this letter represent a small fraction of the larger PA community that shares these
urgent concerns.
For many years, AAPA has pressed for constructive dialogue – while also striving to provide our case for
modernized PA laws to lawmakers in a way that is respectful to the AMA and the vital role of America’s
physicians. However, your ongoing resistance to change, intentional degrading of other health
professions, and the resulting impact on patient care compels us to speak more directly and openly with
lawmakers and the public about the deceitful measures the AMA is taking through its “scope creep”
campaign.
That said, it remains our desire to meet with the AMA before we enter a new legislative year so that we
may come together with agreed-upon solutions to lawmakers. Our patients deserve better, and we are
committed to ensuring that their care and confidence in our healthcare system are not compromised by
misinformation and outdated care delivery models.
Sincerely,
Jason Prevelige, DMSc, MBA, PA-C, DFAAPA Lisa M. Gables, CPA
President and Chair, Board of Directors Chief Executive Officer
AAPA AAPA
CC: James L. Madara, MD
CEO and Executive Vice President,
American Medical Association
The literature is very clear actually and says the opposite of the misinformation you provided.
3-year study of NPs in the ED: Worse outcomes, higher costs
Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. Comparing Hospitalist-Resident to Hospitalist-Midlevel Practitioner Team Performance on Length of Stay and Direct Patient Care Cost - PubMed
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System - PubMed
Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374
A paper that the National Bureau of Economic Research published showed that Nurse practitioners delivering emergency care without physician supervision or collaboration in the Veterans Health Administration increased lengths of stay by 11% and raised 30-day preventable hospitalizations by 20% compared with emergency physicians.
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract00732-5/abstract)
XFurther research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-8256(17)30071-6/fulltext30071-6/fulltext)
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants - PMC
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. Comparing Nurse Practitioner and Physician Prescribing of Psychotropic Medications for Medicaid-Insured Youths - PubMed
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. Factors influencing unexpected disposition after orthopedic ambulatory surgery - PubMed
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns - PubMed
XBoth 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159
96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. "Under the radar": nurse practitioner prescribers and pharmaceutical industry promotions - PubMed
85.02% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%) and medication errors (12.77%). The malpractice cases due to diagnosing errors was further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%). Nurse practitioner malpractice data: Informing nursing education - PubMed
Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits .While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374
APP visits had lower RVUs/visit (2.8 vs. 3.7) and lower patients/hour (1.1 vs. 2.2) compared to physician visits. Higher APP coverage (by 10%) at the ED‐day level was associated with lower patients/clinician hour by 0.12 (95% confidence interval [CI] = −0.15 to −0.10) and lower RVUs/clinician hour by 0.4 (95% CI = −0.5 to −0.3). Increasing APP staffing may not lower staffing costs. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077
When caring for patients with DM, NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21–1.37), endocrinologists (OR = 1.64, 95% CI = 1.48–1.82), and nephrologists (OR = 1.90, 95% CI = 1.67–2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01–1.12) https://onlinelibrary.wiley.com/doi/10.1111/jgs.13662
Ambulatory visits between 2006 and 2011 involving NPs and PAs more frequently resulted in an antibiotic prescription compared with physician-only visits (17% for visits involving NPs and PAs vs 12% for physician-only visits; P < .0001) https://academic.oup.com/ofid/article/3/3/ofw168/2593319
More claims naming PAs and APRNs were paid on behalf of the hospital/practice (38% and 32%, respectively) compared with physicians (8%, P < 0.001) and payment was more likely when APRNs were defendants (1.82, 1.09-3.03) A description of medical malpractice claims involving advanced practice providers - PubMed
Most articles about the role of APRNs do not explicitly define the autonomy of the nurses, compare non-autonomous nurses with physicians, or evaluate nurse-direct protocol-driven care for patients with specific conditions. However, studies like these are often cited in support of the claim that APRNs practicing autonomously provide the same quality of primary care as medical doctors. Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses [Internet] - PubMed
Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence based best practices. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators - PubMed
Inappropriate referrals to pediatric surgeons were more likely to be made by mid-levels lacking pediatric specialization. Referrals to pediatric surgeons from mid-levels had 1.97 times greater odds of being inappropriate than referrals from physicians
https://doi.org/10.1016/j.jpedsurg.2020.06.012
JAMA Surgery that showed increased morbidity and mortality when MD:CRNA ratios went above 1:2.
Burns ML, Saager L, Cassidy RB, Mentz G, Mashour GA, Kheterpal S. Association of Anesthesiologist Staffing Ratio With Surgical Patient Morbidity and Mortality. JAMA Surg. 2022 Sep 1;157(9):807-815. doi: 10.1001/jamasurg.2022.2804. PMID: 35857304; PMCID: PMC9301588.
Comparing urgent care visits between MD/DOs and Midlevels. Doctors saw more complicated patients, addressed more complaints and deprescribed more. Comparing Encounter Characteristics Among Advanced Practice Clinicians and Physicians for Adult Same-Day Visits in Primary and Urgent Care | Journal of General Internal Medicine
The study found that patients of the physician-led team had a 50% less chance of experiencing cardiac arrest and a 27% less chance of death, compared to the original nurse-led rapid response team.
Biopsy rates from midlevels have increased drastically in all states while biopsy rates from dermatologists decreased over the same time frame. Over over 1 in 4 biopsy claims were performed by midlevels.
PAs biopsy more and are less likely to diagnose melanoma in situ. The most common procedure that midlevels do is skin biopsies. Visits in which skin cancers are missed and/or biopsies are performed on benign lesions owing to lower diagnostic accuracy are low-value visits and increase the potential harm to patients.
malpractice suits that name NPs are more likely to result in a successful case for the patient
Amid doctor shortage, NPs and PAs seemed like a fix. Data’s in: Nope.
There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively) Comparing Nurse Practitioner and Physician Prescribing of Psychotropic Medications for Medicaid-Insured Youths - PubMed
Sadly, MD shills do also need psychotherapy, but most are not going there. Its a post about psychotherapy and this lobbyist shill is trying to hijack it.
RFK Jr sees right through shills who are compromised and captured by groups standing to make a ton of money for fake studies, and fake posts and fake articles pushing their agendas.
Horse is out of the barn on providers, if MD’s are this hurt that they lost all their power, why not go after who took it? One is you, you stopped owning practices. Two is third party payers, whom you agreed to pay you. Three is admin costs way outstrip the cost of providers, consider going after these issues, where you are not removing access to healthcare from millions, mindlessly and selfishly. Really using the word “nope” thinking we all don’t know you are MD’s, sad.