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Taz

25 Apr, 16 tweets, 5 min read

The attached commentary is from Reddit(reddit.com/r/Residency/co…). I will be the first to admit that medicine would not be going into the toilet w/o the assistance of irresponsible or lax physicians expediting the process. This MS1 documents their experience with seeing a

2)"Rheumatology NP" in a clinic "supervised" from a distance by a Rheumatologist. NP diagnosed the student with scleroderma--who knows how or why. Fortunately, the MS1 had a fabulous PC physician who advocated for them and found the student an actual Rheumatologist who diagnosed

3)and treated the student accordingly. Knowing that there is no actual ACCREDITED NP curriculum for rheumatology that exists, I decided to see if there was anything that could pass for rheumatology NP "education" and lo and behold, there was. An online curriculum(of course)

4)endorsed by none other than the American College of Rheumatology(ACR). The Association of Rheumatology Health Professionals(ARHP), a division of the ACR, developed the curriculum after forming a task force to assess need and perform a literature review. healio.com/news/rheumatol…

5)The task force abstract: onlinelibrary.wiley.com/doi/abs/10.100…. How nice. How lovely. A medical association, using ACGME core competencies for physicians, created a rheumatology online module for NPs/PAs with the intent of "enriching their training". What training? Another problem--core

6)competencies for physicians are not online. But you know, it's important to spread the rhetoric so the public thinks the "training" is adequate. Not to be outdone, the AANP has decided to put their foot in this tasty piece of rheumatology pie and web.archive.org/web/2021042519…

7)establish their own rheumatologic NP curriculum. Here's what irks me. By ACR lending their name to a curriculum approved and developed by them, it implies the program is credible, as in accredited. I do not care that the task force had private practice and academic

8)rheumatologists on it, I could care less that it is endorsed by the ACR Board of Directors, I don't give a f**k that the RCO parallel's ACGME's core competencies...none of that ensures that NPs/PAs completing this online tool can provide high quality or even basic rheumatologic

9)care. Yes, it is a tool. A stepping stone with good intent. However, it is left to individual, private practice groups and/or hospital groups of rheumatologists to subjectively modify the NPs/PAs for their practice. Using this tool. That might be sufficient for NPs/PAs who are

10)appropriately supervised, but what if they are not, like the NP in the OPs story? We know that sub-specialists frequently use unsupervised NPs/PAs for initial consults, although many NPPs have no where near the foundation needed to evaluate a patient referred by a physician

11)for specialist care. And how will this work, considering the AANP has made it clear that they strongly oppose physicians dictating "education and practice standards for APRNs"? Isn't that exactly what this RCO is doing by using ACGME core competencies in its format? A tool

11)developed specifically for NPs and PAs? This is what happens folks, when the right hand doesn't know what the left hand is doing. When different disciplines have their own agenda, none of it prioritizing patients. Do not confuse "increasing access" to "high quality care". It

12)isn't. Call it what it is, two-tiered care. One for the Haves and another for the Have-nots. It's about business. It's about making a profit. If it was really about the patients, a program could have been developed using unmatched residents with one year of internship under

13)their belt. Or extensions of AP programs like they have in MO, but permitting APs to rotate for 2-3 months in these sub-specialty clinics before returning back to their primary care clinics. Or FM/IM/Peds docs who are interested in cross-training so they can better manage

14)patients in their own communities. Why is it that when we think of increasing access , we never consider these options? I'll tell you why. Because it was never about the patients. Lucky for the OP, they had an "in" as a medical student. Everyone should be so lucky.

@pppforpatients

@pppforpatients @Physicians4Pts #ACR

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More from @Suburbanbella

Taz

@Suburbanbella

26 Apr

A perfect example of physicians being left out of the conversation when it involves healthcare. These fools are intent on making docs obsolete in the provision of rural health care. Invisible. By intent. No doctor on this list. innovation.cms.gov/innovation-mod…

2)Health insurance executives are well-represented. Right at the top. Now take a look at the "hospital representatives". Not one f***ing physician anywhere. One RN. One CRNP. No physician. Let me reiterate for those in the back...HOSPITAL REPRESENTATION, health.pa.gov/topics/Health-…

3)WITHOUT PHYSICIAN REPRESENTATION. This is how non-medical entities control the narrative of health care. So for the docs who keep yapping that this "is the way medicine is going" have relinquished their position in the driver's seat. I'm not one of those docs. Medicine is our

Read 8 tweets

Taz

@Suburbanbella

14 Apr

So this is the response from Envision's CEO to the hubbub that occurred a couple of weeks ago regarding their dismissal of anesthesiologists from WRMC in Wisconsin. It reads as one would expect..I'll leave it at that. He states that "physicians" were not replaced by CRNAs. No one

2)claimed that--I will be more specific and reiterate ANESTHESIOLOGISTS were terminated from WRMC and replaced. And they were not replaced by air. How do I know? Look at the original letter that states they are going to a "100% CRNA model". If they were using CRNAs in this model

3)before, then why was it necessary to make the announcement in the first place? In addition, a lead CRNA will be managing anesthesia services. Not an anesthesiologist. Also note in the letter the statement, "An Envision anesthesiologist will be on staff at this hospital and will

Read 12 tweets

Taz

@Suburbanbella

12 Apr

Welp, EM docs, it's happening...With CMGs opening their own EM residencies, the proliferation of NPP "residencies" and "fellowships" and ignoring the warning by the American Academy of Emergency Physicians(AAEM) in 2016 about the threat of an oversupply of EPs, we finally did it.

2)Created a glut. We already knew compensation was dropping. We witnessed all the EPs being terminated in favor of NPPs who were perceived as saving costs and increasing revenue. IMO, the CMGs developed their own programs for two reasons:
-To control physicians whom they would

3)would train to prioritize metrics and thus increase revenue(thereby engaging in the illegal practice of medicine).
-They needed medical licenses for liability purposes so as not to incur full ownership of NPP malpractice/negligence that would occur because of our failure to

Read 9 tweets

Taz

@Suburbanbella

6 Apr

Most of you who follow me know that I use Twitter to educate and inform. My thread regarding the firing of anesthesiologists at Watertown Regional Medical Center was published in Medscape. There were at least three other Twitter posts on the same topic--apparently mine resonated.

2)The irony is I was actually condemning corporate medicine. The WRMC/Envision decision was not in the best interest of the public. I think corporations should stay the hell out of medicine. Nevertheless, over-sensitive CRNAs and virtue-signaling docs deduced that I was

3)criticizing CRNA practice. I happen to believe that the safest model of practice if one cannot have a 100% anesthesiologist model, is a model in which CRNAs are supervised by anesthesiologists. In addition, I take issue with any CRNAs who claim to practice EXACTLY as

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Taz

@Suburbanbella

4 Apr

@CNotlof

@CNotlof Thank you for your sentiments, greatly appreciated. Before I answer your question, allow me to give you the perspective from which my opinion arises. I am a descendant of people who were lynched, blinded, mutilated, etc. for daring to learn to read and write. But they learned

@CNotlof

@CNotlof 2)anyway. One of the greatest orators of all time, and a former slave, Frederick Douglass, believed that the ability to read and write was the first step to freedom. That history enabled me to be where I am today. I was able to expound on my literacy skills to become what I

@CNotlof

@CNotlof 3)chose, which was a physician. I began lecturing on the value of education while still in college. I never took my education for granted, I viewed it as a gift provided by those who came before. My parents sacrificed a great deal to move us into a neighborhood where Blacks were

Read 10 tweets

Taz

@Suburbanbella

2 Apr

There is a misperception that Physicians for Patient Protection(PPP) only advocates for or opposes scope creep issues related to NPs/PAs. Nope. We oppose anyone attempting to practice medicine w/o a license. Attached is info on pending or active legislation in almost every state

2)regarding CRNAs, CNMs, naturopaths, , pharmacists, optometrists, psychologists, etc. It's exhausting. We do this because we have to. Because it is in the best interest of the public. We inform the public so they also know and can protect themselves against people practicing

3)beyond their scope. An informed patient is an empowered patient. We don't have lobbyists, who are incredibly expensive, so we do the legwork ourselves. We volunteer our time willingly--it is essential to our mission, which is to protect patients and the integrity of the

Read 5 tweets

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