I avoid controversy. Like the plague. Don’t get me wrong, I have very clear and very strong opinions, I just do not feel the need to share them with everyone or try to convince you that mine are right. You do you. It might be wrong…but it does not impact me. However, today, I feel compelled to tell you to immediately start asking about the credentials of healthcare providers.
I am not an activist, but I am eternally grateful for the women’s rights movement which has made incredible progress over the years.
Women are not second-class citizens, and it is a fight that continues to be fought in terms of power, prestige, pay and job opportunities.
I would not be able to blog or discuss healthcare as a successful surgeon if the civil rights movement did not occur.
Thankfully, ordinary people stood up and sounded the alarm. Again, there is still much work to be done and a batch of new leaders are taking the helm.
What does this have to do with healthcare? Well, I have been sitting on the sidelines watching an ugly trend increase.
I have watched valiant physicians sounding the alarm that something is happening that will impact us all. I have been sitting quietly applauding those that shouted.
But now, I feel an undeniable pull that has urged me to add my voice. My 25 years of experience in healthcare in different roles as a military physician, as a private practice physician and as an employed physician has given me several perspectives.
Healthcare is dependent on money
Healthcare is expensive. And sadly, most people associate these costs with physicians. If you are one of those people, YOU ARE WRONG.
Today, there are more layers of healthcare management than ever before. Although these jobs are important, they do not directly add to actual healthcare, and these costs are eating up healthcare dollars.
And don’t forget the top healthcare CEO’s who also benefitted from increasing salaries. This money needs to come from somewhere. So, these administrative salaries also make costs rise, but profits still need to be obtained somehow. Guess where the additional profits come from?
As hospital systems began to seek ways to increase their profits, some of them looked at physicians. Yes, these are well-trained, dedicated providers, but administrators had to find some way to provide care cheaper. And then they found a way.
In order to see more patients and make additional revenue, more healthcare providers were needed. However, paying for an increasing number of physicians became an issue.
The brainchild to answer the need for increased profits was to create more mid-level provider positions. Meaning, that instead of solely hiring fully trained physicians, an increasing number of nurse practitioners (NP) and physician assistants (PA) have been hired.
Increasing use of midlevel providers has been helpful
Initially, many of these roles were designed to fill areas of physician shortages in rural areas. Later these roles were expanded to supplement care in physician practices where the midlevels would see patients and be directly supervised by physicians.
Physicians who would read and sign their charts to make sure nothing was missed and also review prescriptions to make sure appropriate medications and dosages were correct. It was indeed a collaborative partnership.
But some healthcare systems just saw dollars. More patients could be seen, and the NP or PA was less expensive than hiring another physician. Consequently, the ratios started changing.
First, it was several physicians to one midlevel, then it changed to a 1:1 ratio, now, sometimes, the midlevels outnumber the physicians.
However, the physicians are often still “supervising” the midlevels even though they are not able to check the notes or prescriptions. Nurse Practitioners then decided to expand their roles and lobbied state governments to give them the ability to practice medicine without any physician supervision.
Midlevel providers began to work as physician equivalents
Think about that. In 23 states plus Washington, DC, nurse practitioner healthcare providers have complete practices where they see, diagnose, and treat patients with no oversight from a physician. Umm, do you think the years of medical training, internship, and residency are just for fun and games?
The extensive training required by all physicians provides a more in-depth educational experience compared to nurse practitioners. Nurse practitioner education and training is not standardized and varies based on the program. Some programs are 100% online.
I have witnessed this shift of midlevel providers working without a supervisor by following my sister’s career. She is an Emergency Room (ER) physician who has worked across the entire country, has managed a trauma center and was the supervisor an ambulance system. She knows her stuff!
Her work experiences include a variety of practices included those that only hired physicians, those that required her to supervise midlevel providers and has sadly worked in those where she might be the only physician on a shift.
Do you know this when you bring your child to the ER for stomach pain? How about when your father is seen for chest pain? Do you know that there are some ERs in the country that ONLY staff with midlevel providers?
Physicians have been punished for discussing this situation
As I have witnessed this transition of increasing usage of lesser trained healthcare providers, I have been moved to get out of my safe corner. It is not directly impacting me in my personal practice, but it is impacting physicians every day around the country.
Some physicians have been fired for not training midlevels. Some of have been fired for speaking out about the system. One physician was fired shortly after writing an informative post like this.
There are cases where a patient in the ER did not like the care she was receiving and asked to see the physician. She was told that the PA or NP is the same as a physician. Nope.
When people request to see a physician in some offices, they are told there are no appointments for months or at all. This forces people to use the less expensive, less trained providers. They feel that they have no choice.
You have a choice in healthcare…but you must ASK
But you do have a choice. Starting today, when you receive healthcare, you must ask about the credentials of your provider. There is an absolute need for midlevels, but it is not to replace physicians! They should be supplementing our care.
Many midlevel providers work hard to inform patients who they are and what their credentials are. But some do not. You should feel free to ask a provider about their training, how long they have been in that job or how long in that field.
We pay good money for healthcare. When we are seen by midlevels, do we pay less for the visit? No. How are we benefitting from using increasing numbers of the midlevels?
Well, we are all getting increasing access to healthcare, so midlevel providers are incredible for allowing this to happen. However, their level of expertise should continue to allow them to function in their trained capacity and not as a fully trained medical physician.
I believe everyone should have the option to see a physician.
Why did I finally decide to speak out?
So why now? What motivated me to leave the comfort and safety of my little quiet corner?
Could it be my concern for my young adult daughters who have their own insurance and will navigate the healthcare system independently? Do I worry that they will be given medical advice that is not from the highest authority? Maybe.
Could it be that my husband and I are reaching an age bracket where we will be seeing healthcare providers more frequently? Am I worried that this trend will continue and gaining access to actual physicians might be difficult in the future? Maybe.
Actually, the true reason caught me off guard.
I performed surgery on an infant a few years ago. The family moved out-of-state and recently returned to Georgia; however, she returned to a different part of the city.
When new health issues occurred, my patient was referred to a local ENT office. The child was evaluated and recommended to have surgery. The mom told the new ENT about her previous experiences with me.
Mom was happy to hear good things about me! (Whew, so was I!) She was also told that the new ENT had worked with me for years in the past.
Ultimately, my patient’s family decided to drive across town to see me for a second opinion. After my evaluation, I started asking more about her other ENT…you know… so I can thank someone for showing me some professional love!
The other provider was a female pediatric ENT!
Woohoo! There are only a few of us in Atlanta. So, I described each woman. Nope.
I was confused and really needed to solve this mystery. Finally, Mom checked her phone and found the name.
I was stunned. Not only was her provider NOT a pediatric ENT, but the provider was not a physician! So, obviously, she was also not a surgeon!
I then shared with Mom that I had enjoyed working with this provider but informed her that the woman was a nurse practitioner. Now Mom was stunned
Then she became angry and began showering me with questions. Why didn’t she tell me? Why didn’t she let me see the actual physician? Was I only going to find out on the day of surgery?
These were all good questions. But sadly, the reason she didn’t know these answers is that she didn’t ask!
It seems that healthcare delivery can sometimes use a “Don’t Ask Don’t Tell” protocol. People make assumptions that are not true.
The range of emotions that I witnessed from Mom pushed me over the edge. She simply didn’t know that she had to ask. How many other people are in this situation? At least this patient would have eventually seen a true ENT surgeon because, at this time, midlevels do not perform these surgeries. Yet.
Listen to my voice: Ask about the credentials of healthcare providers
I have a unique position where my voice could save unsuspecting future patients from having anguish because they were uninformed. And so despite my desire to have others share this information, I know it is my turn.
I am now standing up and saying my piece. You can do with it what you will.
Nurse practitioners and physician assistants serve an invaluable role in our healthcare system. They absolutely provide excellent care. They are just not physicians, so you need to know the source and experience level of your providers!
You MUST ask for the credentials of healthcare providers. You need to be able to decide if you want a higher level of care for a complicated, persistent or progressive problem.
Midlevel healthcare providers were initially hired to practice in primary care but have been expanded to become medical and surgical specialists. Some are working in Dermatology clinics, independently treating cancerous skin lesions. Yikes.
So there. I said it. I have stood up and made my voice heard.
This is an unfamiliar place for me, and I am bracing for some serious backlash. Thank goodness I have cloaked myself in an invisible force shield, like in Star Wars. The negativity will come, and I plan to watch it bounce back on them. Pray for me that my force shield holds!
Or I may become a turtle and stick my head back in my shell and go back to my corner.
Regardless of the outcome of this post, the problem still exists. Research it. Understand who your providers are and their level of training and experience.
You have the right to be seen by physicians!
Eventually, I will share more insight about the training differences between nurse providers, physician assistants, and physicians. They are not the same. What do you deserve?
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