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Patients at Risk

Author: Rebekah Bernard MD and Niran Al-Agba MD

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Patients at Risk exposes the political maneuvering and corporate greed that has led to the replacement of physicians by lesser trained practitioners, including nurse practitioners and physician assistants. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for our nation’s healthcare guardians continue to decline—with deadly consequences. This is a story that has not yet been told, and one that has dangerous repercussions for all Americans.
52 Episodes
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In the book Patients at Risk, we discuss the tragic case of Alexus Ochoa, a 19-year-old woman who died when a nurse practitioner failed to diagnose the blood clot in her lungs. The nurse practitioner was unprepared to treat emergency room patients and there was no physician on-site, even though the hospital advertised that physicians were available 24/7. Today we are joined with attorney Travis Dunn, one of the lead attorneys who helped Alexus’s family win a major financial settlement against Mercy Health Systems for replacing physicians with nurse practitioners.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Watch the video on our YouTube channel, Patients at Risk: https://www.youtube.com/channel/UCLLDpz_f6u7EuW-BKnar-AA
There are so many challenges in healthcare today, and it’s becoming ever more difficult to practice medicine. In fact, many physicians that could continue to work well into their golden years are retiring as soon as they can because the struggle of practicing medicine is just no longer worth it to them.Today we are joined by an amazing physician who has experienced his share of heartache within our healthcare system. Dr. Mark Lopatin is a rheumatologist who has written extensively about his experiences, and he joins to share his insights and thoughts about how we can improve our broken healthcare system.   Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Dr. Lopatin's writing:"I knew she was trouble" -   https://judiciary.pasenategop.com/wp-content/uploads/sites/42/2020/09/Article-Mark-Lopatin-MD.pdf"The facts did not matter"  = https://mail.google.com/mail/u/0/#search/mlopatin%40comcast.net/FMfcgzGljvNMgRKMzxvTnTCJSXrMsxnD?projector=1&messagePartId=0.1"This physician is retiring: here is his most valuable lesson" = https://www.kevinmd.com/blog/2020/12/this-physician-is-retiring-heres-his-most-valuable-lesson.html
Today, we discuss a topic that is near and dear to my heart as a family physician: the role of primary care. We’re going to focus especially on the misconception often held by legislators that primary care is somehow ‘easy,’ and can therefore be relegated to allied health professionals, especially nurse practitioners.Today, I am joined by two special guests who are experts in the role of primary care in the healthcare system. Dr. Emily O’Rourke is a Family Physician in Virginia and the owner of Fountain Direct Primary Care.  (https://fountaindirectprimarycare.com) We are also joined by Dr. Meghan Galer, a board-certified emergency physician who opened her own direct primary care practice, ColGACare, in Georgia. (https://www.colgacare.com)Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/References:BMJ 2018 - Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality https://bmjopen.bmj.com/content/8/6/e021161 BMJ 2019 - US patients live longer in areas with more primary care doctors, study finds BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l804 (Published 20 February 2019) BMJ 2019;364:l804Mortality rates are lower with higher continuity of care, review finds BMJ 2020;370:m3184Lancet: http://dx.doi.org/10.1136/bmjgh-2017-000424Gray BM, Vandergrift JL, McCoy RG, et al Association between primary care physician diagnostic knowledge and death, hospitalisation and emergency department visits following an outpatient visit at risk for diagnostic error: a retrospective cohort study using medicare claims BMJ Open 2021;11:e041817. doi: 10.1136/bmjopen-2020-041817 http://dx.doi.org/10.1136/bmjopen-2020-041817
In our book, we outline the tragic case of Alexus Ochoa, a 19-year-old woman who died when a nurse practitioner failed to properly diagnose and treat the blood clot in her lungs.  The only reason that the details of this case became public was because of a lawsuit filed by the patient’s family. Court records reveal not only a lack of appropriate medical care, but more importantly, the incredible efforts that Mercy Health Systems, a multi-billion-dollar corporation, routinely went through to hire and credential nurse practitioners to work in positions completely outside of their scope of practice, putting patients at risk to save money and increase profits. Today we talk with attorney Robert Painter about the role of the legal system in holding bad actors like this accountable.  Mr. Painter is a former hospital administrator who is now a medical malpractice and wrongful death lawyer at Painter Law Firm in Houston, Texas. https://painterfirm.com/Get the book! Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
One of the biggest challenges in healthcare today is a lack of transparency when it comes to the training and licensure of healthcare professionals. As members of the healthcare team have taken an increased role in providing medical care, patients may be treated by physicians, nurse practitioners, physician assistants, and other healthcare practitioners, and understanding who is who can be difficult.  In fact, an AMA study found that only 55%  of respondents thought it was easy to identify who is a licensed physician. Moreover, 79% of respondents said that they would support legislation to require that patients be informed of the level of education, skills, and training of all health care professionals. Fortunately, some states are taking action to ensure truth and transparency among healthcare practitioners, with New Jersey leading the way.  Today we are joined by two special guests to discuss the New Jersey Health Care Transparency Act, which was passed in 2020: Marlene  Kalayilparampil, MHA, FHELA is the manager of government relations for the Medical Society of New Jersey, and Dr. Flowers is a practicing physician in New Jersey. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/premium/arc/tia-survey_0.pdf
There is an increasing double standard in the practice of medicine and the practice of advanced nursing, and one of these is the difference in ‘board certification.’  Nurse practitioners take just one board examination in the course of their career, which is 3 hours long and 200 questions. Nurse practitioners never have to take another exam – they just have to submit their work hours, which can even be volunteer hours. In contrast, physician board exams are most more rigorous, lasting 9-10 hours or more, and must be repeated every 7-10 years. In 2015 the American Board of Medical Specialties added another layer to the process, requiring that physicians participate in a continuous “Maintenance of Certification” (or MOC) process to maintain board certification. Many physicians balked at the increased burden and cost of this MOC process, and grassroots organizations even sprung up to provide alternate pathways to make it easier for physicians to practice medicine. Today we are talking with Dr. Paul Mathew, a neurologist and a board member of the National Board of Physicians and Surgeons. Get the book 'Patients at Risk:" https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Join PPP: https://physiciansforpatientprotection.orgCertify with the National Board of Physicians and Surgeons: https://nbpas.org
Seven-year-old Betty died just 15 hours after she was evaluated by a pediatric nurse practitioner in a pediatric urgent care without any physician on site.  Betty's father, Jeremy Wattenbarger discusses the efforts he has made to seek accountability and ensure that other children receive physician-led care.Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Many of our critics accuse us of exaggerating the risks that patients face when physicians are replaced by lesser trained members of the healthcare team.  We are often told that we are engaging in a ‘turf war’ with nurse practitioners and physician assistants and that we should support these nonphysicians practicing ‘to the full extent of their license and training. ’  Today we are going to explain exactly why we take such a hardline stance against the independent practice by nonphysicians. It’s not because of a turf war - it’s because of patients like seven-year of Betty Wattenbarger, who died after a pediatric nurse practitioner failed to diagnose her with pneumonia and sepsis, an overwhelming blood infection.  Betty’s father, Jeremy, is on a crusade to ensure that other parents do not lose their children because of a lack of access to care by a properly trained physician. Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
In part 2 of our discussion about healthcare politics,  Dr. Kermit Jones, a California internal medicine physician, attorney, and military veteran discusses his run for California's 4th Congressional District.Learn more about Dr. Jones at his website - https://kermitjonesmdjd.com/Donate to Dr. Jones' political campaign here - https://secure.actblue.com/donate/kermitjonesforcongress2Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Physicians: Join us at htpps://Physiciansfor PatientProtection.org.
More than ever, healthcare and politics are intertwined. Decisions made by politicians and have a major impact on not only healthcare policy, but on the day-to-day practice of medicine by physicians. Today we are excited to be talking about healthcare politics with Dr. Kermit Jones, a California internal medicine physician, attorney, and military veteran who is working to bring his medical expertise into the political arena. Learn more about Dr. Jones at his website - https://kermitjonesmdjd.com/Donate to Dr. Jones' political campaign here - https://secure.actblue.com/donate/kermitjonesforcongress2 Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Physicians: Join Physicians for Patient Protection - https://physiciansforpatientprotection.org
In part 2 of this discussion with Dr. Marion Mass, a pediatrician and the co-founder of Practicing Physicians of America, we learn about the impact of group purchasing organizations (GPOs) on the high cost of healthcare.  In 1987, the federal legislature granted GPOs safe harbor from anti-kickback statutes, allowing them to reap millions of dollars. Dr Mass also explains how these GPOs have created artificial shortages in essential medical supplies, leading to patient and clinician harm.Practicing Physicians of America: https://practicingphysician.org/Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
We all know that the health care system in the United States is expensive, with the U.S. spending more than any other developed nation. Although it’s convenient to scapegoat doctors as the reason for high medical costs, the truth is that physician compensation makes up just 20% of total health spending.  So, who is really responsible for the astronomical cost of health care today? To get some answers, we are joined by Dr. Marion Mass, a pediatrician and the co-founder of Practicing Physicians of America.  In part 1 of this series, Dr. Mass explains how Pharmacy Benefit Managers (PBMs) have benefited from safe harbor from anti-kickback statues, allowing them to reap millions of dollars and increasing drug costs for Americans.Practicing Physicians of America: https://practicingphysician.org/Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
On our last podcast, advocacy experts Dr. Purvi Parikh and Linda Lambert discussed steps that physicians can take to advocate for their patients and for the profession of medicine. In part 2, we learn from the legislative successes of the nursing profession.   We discuss how to write a resolution for your medical society to help influence policy, and how advocacy can be a solution to burnout.Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Physicians are usually so busy taking care of patients that we sometimes ignore the political aspects of healthcare, leaving the decisions to legislators and policymakers, many of whom do not truly understand what it is like to deliver medical trenches in the trenches. Unfortunately, the old adage, “if you’re not at the table, you’re on the table,” is nowhere truer than in the healthcare legislative process.Today, I am joined by two experts to help us understand how physicians can be effectively involved in advocacy for our patients and for our profession.Dr. Purvi Parikh is an allergist and immunologist practicing in New York who has been involved in political advocacy since she was a medical student. She is also a fellow board member of Physicians for Patient Protection. Linda Lambert served as the executive director for the New York chapter of the American College of Physicians for over 20 years and has spent the last several years of her pseudo-retirement helping Physicians for Patient Protection build our organization.
When it comes to discussing the differences between physician assistants (PAs) and physicians, there is no one better to address the issues than someone who has trained and worked in both professions.  Christin Giordano MD was a PA before deciding to return to medical school to become a physician. She has since completed residency training and a fellowship to become a nephrologist.  We are also joined by Elizabeth Ennis, PA-C, a former classmate of Dr. Giordano, who is currently practicing in California.  Together, we discuss the state of the PA profession, including the proposed name change from 'physician assistant' to 'physician associate' and independent practice for PAs.Read Dr Giordano's KevinMD post:  From PA to MD: An appreciation for physician educationGet the book Patients at Risk!
One of the biggest issues in medicine today is physician burnout, with almost 50% of all physicians reporting making active plans to leave the practice of medicine. We are joined by an expert on the subject of physician wellness, psychiatrist Wendy Dean. Dr. Dean and her co-author have singlehandedly changed the dialogue away from ‘burnout’ and towards the concept of ‘moral injury.’  We asked Dr. Dean for her perspective on the impact of corporatization and the replacement of physicians by nonphysician practitioners on physician morale and burnout.Dr. Dean's landmark article: https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/And Dr. Dean's article on her experience with the healthcare system:https://www.wbur.org/commonhealth/2020/01/24/moral-injury-american-medicine Dr Dean's website and podcast:  https://fixmoralinjury.org/ https://podcasts.apple.com/us/podcast/moral-matters/id1529907905Get the book: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
We are joined by Eric Starkman, an investigative journalist who works to shed light on dangerous corporate practices in healthcare. Mr. Starkman is relentless in exposing the work of bad actors in the medical-industrial complex and discusses how the replacement of physicians by nonphysician practitioners is contributing to the decline of the U.S. healthcare system.Read Eric Starkman's article about the book 'Patients at Risk' here.An excerpt:  "The deceit are the studies purportedly showing that NP and PA patient outcomes are statistically the same as medical doctors. According to Niran Al-Agba and Rebekah Bernard, the MD authors of “Patients at Risk,” all of the studies involved NPs and PAs who worked under the supervision of doctors. The authors insist there are no credible studies evaluating patient outcomes involving NPs and PAs working without medical supervision, which they are doing with increasing frequency.The corruption is that hospitals and other healthcare facilities are increasingly foisting NPs and PAs on patients without patients knowing it. The trend in healthcare today is to refer to everyone who interacts with patients as “healthcare providers” and they all wear white coats. At some hospitals, even the orderlies and housekeeping staff wear white coats, so it’s impossible to distinguish the real doctors among the white coat brigades.Nurse practitioners and physician assistants aren’t real doctors. They can’t, don’t, and never will provide comparable medical care. They’re MD Lites – Less training. Less knowledge. Less skills."Get the book! 
About 42% of physicians report feeling burned out, and about half of all doctors are making active plans to leave the practice of medicine. Unfortunately, some doctors turn to drugs and alcohol to cope with the stressors of medicine, which may result in the loss of their professional licenses. Today, we are talking with Dr. Daniel Hochman, a psychiatrist, and an online professional recovery program creator to discuss physician well-being.  Get the book!  https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Dr. Daniel Hochman's online recovery program: https://www.selfrecovery.org/about-dr-hochman/Physician support line:  1 (888) 409-0141      https://www.physiciansupportline.com/ "Psychiatrists helping our US physician colleagues and medical students navigate the many intersections of our personal and professional lives"  - free and confidential
On May 24, 2021, JAMA, or the Journal of the American Medical Association, published a viewpoint entitled:  “Advanced Practice Clinicians—Neurology’s Underused Resource.” The article was authored by nurse practitioner Calli Cook and Dr Heidi Schwarz, a neurologist with the University of Rochester and argued that due to a shortage of neurologists across the country, non-physician practitioners should be used more widely to provide neurology care to patients. Physicians for Patient Protection submitted a letter to the editor expressing concerns about these viewpoints, however, JAMA Neurology declined to print our letter, citing space concerns and "your letter did not receive a high enough priority rating for publication."Neurologist/ psychiatrist Dr. Alyson Maloy and neurologist Dr. Carol Nelson join me to discuss the replacement of neurologists by nonphysician practitioners.Link to JAMA Neurology article: https://jamanetwork.com/journals/jamaneurology/article-abstract/2780419Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Join physiciansforpatientprotection.org
One of the ways that corporations have been successful in replacing physicians with lesser-trained medical practitioners is by creating a sense of equivalence so that patients think that the care they will receive is “the same.” For example, both physicians and nurse practitioners and physician assistants wear white coats, have similar-appearing badges, and may be referred to as “doctor” even if that doctorate is not a medical degree.  Not only do these corporations elevate the role of nonphysicians, they also work to bring down the level of physicians.  On many health system websites, physicians are listed as mere “providers.” The once-named “doctor’s lounge” is now the provider’s lounge. And now, some institutions have even taken aim at “Doctor’s Day,” hijacking the one day devoted to showing appreciation for physicians and turning the focus instead on the healthcare ‘team’.Today, Dr. Marsha Haley, a radiation oncologist, joins us to discuss an article that she wrote for the Buck’s County Courier Times about the appropriation of ‘Doctor’s Day’. Get the book!  https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Dr. Haley's article:  https://www.goerie.com/story/opinion/2021/04/18/op-ed-doctors-shouldnt-have-share-their-day-especially-year/7219700002/Vanity Fair article discussing group purchasing organizations (GPOs) and their contribution to a shortage of PPE - includes details that Kevin W. Sowers, RN, MSN, the president of Johns Hopkins Health System, was a board member of a GPO that began servicing the hospital system after Sowers became the system's leader.https://www.vanityfair.com/news/2020/05/corporate-deals-making-hospitals-ppe-shortages-worse May 2020
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