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Taz

20 Jul, 17 tweets, 5 min read

The corporate practice of medicine(CPOM) is killing medicine. It's happened again. Docs being displaced under the guise of providing "continued excellent care" or some other rhetorical bulls**t. Along with the "collaborative" blah, blah, blah hogwash. Sigh....Were I one of the

2)docs reading this letter, I would be offended that Dr. Gard would presume he could dictate who I could speak to about a patient. He doesn't own my license and he has no say. If a doc wants to talk to a doc, no one can say a f***ing word. Their choice if it is their patient.

3)How is dictating the conditions on when a doc can speak to another collaborative? Also, if the team is truly a dyad, then that's one doc to one NPP. Should be no problem if the NPP is presenting the patients as he/she should since Georgia is a non-FPA state. Unless they plan

4)on ignoring the law. If one doc is covering several NPPs, then EACH relationship is a technically a dyad. Also, are the NPPs qualified to practice as hospitalists? Because there are no accredited NP/PA hospitalist programs in the U.S. There is only one accredited post-graduate

5)PA fellowship/residency in the U.S. and that is the critical care "residency" at Emory. Accredited by the Accreditation Review Commission on Education for the
Physician Assistant(ACR-PA)--the body that accredits PA programs. arc-pa.org/postgraduate-a…. The residency is a combined

6)program that includes NPs. No accreditation on that side though. So back to the story. There are 3 PA "Hospitalist" programs in the U.S.; none are accredited. Turns out accreditation of post-grad PA programs is not mandatory. paschoolfinder.com/cat/hospitalis…

7)Couldn't find anything on NP "Hospitalist" programs. Just saw one that is a combined program in the Carolinas Health System(Atrium Health). So how do we know if NPPs are qualified if the programs that do exist are not accredited and there is no nationally standardized

8)competency exams? We don't. Programs like the Mayo Clinic can ride on their names and defer to their overall accreditation status to suggest their programs are legit. Mayo's has been around since 2007, so it is well established. Mayo planned to seek accreditation..not sure what

9)occurred since they are not accredited by ARC-PA as of yet. In regards to NPs, it is most likely those working as "Hospitalists" are Family Nurse Practitioners(FNPs). FNPs are not qualified to work as hospitalists since FNP programs are outpatient programs by design. But FNP

10)SOP varies from state to state. No one asks, no one checks and no one cares. Not when CPOM is running the show. What is the likelihood that the Dr. Gard or the credentialers at Memorial University Medical Center validated the qualifications of the NP "Hospitalists"? Are they

11)FNPs or Adult-Geriatric Nurse Practitioners(AGNPs), whose population focus includes some of the types of patients admitted to the hospitalist service? I'd say unlikely. If AGNPs, did they complete both an acute care(AC) and primary care(PC) curriculum? If no AC, they should

12)not be caring for patients who may decompensate and require acute care. Period. Not in their SOP. And they do not have the training or scope of IM/FM docs who can and do work as hospitalists.

13)No employer, contract medical group(CMG), hospital, etc. can expand the SOP of any NP. Only the BON can do that by way of legislation. So the hospitalists responsible for supervising NPs who may be practicing outside their SOP, know that you may be held liable for a patient

14)who complains about their care--for aiding and abetting the illegal practice of medicine. That's when the BOM gets involved. These are the pesky legal details that are never shared with docs who take on tremendous responsibility for patients they never see or whose charts

15)they review after the fact. authenticmedicine.com/2020/12/an-edu…

16)Sadly, more hospitals are demanding IM/FM docs complete accredited fellowships in hospitalist medicine before they can work as hospitalists. Yeah. Wanna take a guess who owns Sound Physicians? United Health Group/Optum and the PE group Summit Partners. This, ladies and

@TakeMedBack

17)gentlemen, is the corporate practice of medicine. Sound's decision in this case...Well, let's just say it is very unsound. fiercehealthcare.com/payer/unitedhe… @TakeMedBack @pppforpatients @Physicians4Pts @mass_marion @Free2CareHC

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More from @Suburbanbella

Taz

@Suburbanbella

18 Jul

Every physician, fellow, resident and medical student should read this article. It remains as relevant as the time it was written in 2014. I will share excerpts that I believe most exemplify what we are experiencing today. They thehealthcareblog.com/blog/2014/09/1…

2)clarify the tactics used by corporate entities to control physicians who are strong patient advocates. And my suggestions on ways to take our power back. Unfortunately, the vitriol that docs think we are gods is prevalent. The toxic environment in which docs are trained

3)today virtually ensures that is not the case. Nevertheless, the false claim still prevails. Doesn't help to have virtue-signaling docs perpetuate the hype. Docs, you matter and patients matter. Never forget that, despite the gaslighting.

Read 11 tweets

Taz

@Suburbanbella

15 Jul

MedTwitter, this is what a spin to feigned victimhood looks like. In real time. This is intended especially for the virtue-signalers who come in on the tail end of the conversation and never see when the NPPs initiate s**t. This doc asked a simple question. Probably could have

2)left off questioning whether the person was in healthcare as it is triggering. Nevertheless, the instigator's commentary as to why RRTs began is also triggering. And false. And this is where a conversation that could have been civil goes south. So instigator says, "To have the

3)hubris to say because you have a certain degree....". No where did the doc say any such thing. Nowhere. But someone entering the middle of the conversation will think she did. This is how bullying begins and the spin becomes accepted as fact. Instigating unnecessary s**t for no

Read 7 tweets

Taz

@Suburbanbella

7 Jul

I like analogies that are apropo. Healthcare is a cesspool of Pimps, Hoes and Johns. I discussed the transformation of medicine in this article for Authentic Medicine(authenticmedicine.com/2020/09/the-me…). I elaborated on Pimp #1(RWJF), who approached the National Academy of Medicine(NAM),

2)aka "The Hoes", for a White Paper on the Future of Nursing campaign which was designed to transition physician-led medicine to nursing-led. The Hoes didn't care that nurses aren't trained to practice medicine, they got on board with the campaign. The goal in 2010....

3)Never mind that the Hoes and Pimp #1 had no idea how to competently increase the nursing/NP pool w/o compromising education. They didn't care about that either. Enter the online, substandard NP degree mills graduating NPs who cannot even practice as nurses, let alone NPs. But

Read 17 tweets

Taz

@Suburbanbella

30 Jun

All EM docs and residents out there in Twitterland need to view this video. Summarizes the f***ed up situation with my beloved specialty--in a nutshell. Beautifully done. I remember the days when I would be hired for a job, sight unseen. Sent in my CV and

2)boom, I was hired. My training was spectacular and my attendings supportive. And I recall when I became concerned about the changing landscape of EM, especially when CMGs began to become more prominent and small democratic groups sold their practices. We did this. We gave away

3)EM. To everybody. It took a while for the damage to manifest, but now it's here. I'm so proud of the beginnings of EM. The goal was to improve care to critically ill and trauma patients by aggressive intervention. And we did, we improved survival rates. Now we are going

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Taz

@Suburbanbella

30 Jun

CA docs: I was unaware of the class action lawsuit against Sutter Health, the largest health care system(and a non-profit) in northern CA. They settled a $575 million dollar antitrust class action lawsuit alleging anticompetitive practices that drove up revcycleintelligence.com/news/judge-app…

2)the cost of health care services in the region. Just when the case was set to go to trial in 2019, they decided to settle. It is interesting to note that in November 2017, Sutter was sanctioned by the judge for "intentionally destroying 192 pieces of evidence that were relevant

3)to antitrust issues". It is mind-boggling that costs were much higher in northern than southern CA, considering southern CA has a higher cost-of-living and is more congested. Sacramento, my home town, has the most expensive maternity care IN THE NATION! More expensive than the

Read 5 tweets

Taz

@Suburbanbella

29 Jun

Deception is so common in scope creep that it barely raises an eyebrow. Words matter, context matters. So a bit of education...Here is an ad seeking a "collaborating" or supervising doc for a NP practice in MA. Collaboration is not supervision. By the ad, the poster is clearly

2)seeking a doc to function as a safety net; however, a lot of NPs hate the term "supervision". They prefer the misnomer, "collaboration", which connotes being on an equal plane with doctors. Here's the kicker though. MA is an unsupervised state, the governor signed it into law

3)in Jan 2021. So exactly what "supervisory regulations" have to be met? In addition, this highly desirable position is offering the "collaborating" physician a whopping $400-$500/month for the use of his license in case s**t goes south. That's about one hour's compensation for

Read 12 tweets

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