July 30, 2024 • 24 mins
In the first of a series 'The Nurse Will See You Now,' Bloomberg reporters investigate concerns about nurse practitioner education.
The Miseducation of America’s Nurse Practitioners
They don’t merely support doctors—NPs increasingly treat patients independently, including in specialty practices and emergency rooms. When they aren’t well trained, the results can be tragic. By Caleb Melby, Polly Mosendz, and Noah Buhayar
https://www.bloomberg.com/news/features/2024-07-24/is-the-nurse-practitioner-job-boom-putting-us-health-care-at-risk
Patients at Risk podcast episodes with nurses interviewed for the Bloomberg article:
Rayne Thoman, RN - Episodes 13, 14
John Canion, NP - Episodes 91-93
PhysiciansForPatientProtection.org
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:07):
Welcome to Patients at Risk, adiscussion of the dangers that
patients face when physiciansare replaced with non physician
practitioners.
I'm your host and the co authorof the book, Patients at Risk,
and the author of the follow upbook, Impostor Doctors.
Rebecca Bernard.
Today, I'm sharing a breakingarticle from Bloomberg Business
(00:28):
by investigative journalistCaleb Melby and colleagues, and
it's called The Miseducation ofAmerica's Nurse Practitioners.
Was published just this lastweek, and I'll share the link in
the podcast notes.
Now we first learned about CalebMelby when it comes to nurse
practitioners, because he wasone of the investigative
(00:51):
journalists researching thecompany Cerebral and others like
that.
There was another one calledDunn and various others.
That really became prominentduring the COVID 19 pandemic,
especially during stay at homeorders.
And these companies wereoffering at home mental health
care.
And in particular, they wereoffering controlled substance
(01:15):
medications for ADD and led to areally significant rise in the
number of stimulantprescriptions.
So Melby and his colleagueswrote some articles that
basically discussed concernsabout this rise in these
medications, the potentialimpact on patients.
Perhaps that work led to some ofwhat we're seeing now, which is
(01:39):
that the CEO of Dunn wasactually arrested along with the
company's clinical president forfraud, because they provided
easy access to stimulants likeAdderall and Ritalin over the
internet, For monthlysubscription fees.
And of course, these companiesalmost exclusively hired nurse
(02:03):
practitioners and notphysicians.
So Caleb Melby and hiscolleagues at Bloomberg,
apparently this raised somealarms to them.
Why are there so many nursepractitioners working for these
companies?
I did receive an email from Mr.
Melby in December of last year.
that he had actually gotten acopy of Patients at Risk and was
(02:26):
reading it and really interestedin the topic and wanted to
explore this significant growthin nurse practitioners.
So just this last week,published the first in what is
going to be a series on nursepractitioners.
And the first article was titledthe Miseducation of America's
(02:46):
Nurse Practitioners.
And the title says they don'tmerely support doctors.
NPs increasingly treat patientsindependently, including in
specialty practices andemergency rooms.
When they aren't well trained,the results can be tragic.
And this article shares.
Stories and Anecdotes ofPatients That Were Harmed by
(03:09):
Improperly Trained NursePractitioners.
For example, the first storythey share is the story of Fred
Bedell.
He went into an emergencydepartment in 2020 with severe
abdominal pain.
And he, of course, as we areseeing increasingly, did not
receive care from an emergencyphysician or even any medical
(03:32):
doctor.
In fact, he was cared for by anurse practitioner who had just
received his license four monthsprior The nurse practitioner
found that the patient's bloodsugar was nearly 600.
And of course that should haverequired admission, but he
decided to send the patient homewhere he died of diabetic
(03:55):
ketoacidosis.
So the article cites asettlement from the hospital
company, which was HCAHealthcare, One of the largest
for profit health systems in thecountry the settlement paid out
750, 000.
The article says that the familymembers can't discuss the case
because of that payout, but theinvestigators on their review,
(04:19):
Cannot see any evidence that aphysician, was ever involved in
the care of the patient.
Now, the article points out thatthis is not unusual, that there
are now they say more than300,000 nurse practitioners, but
actually the A A NP.
In their most recent article ontheir website says that there
are 385, 000 nurse practitionersnow.
(04:43):
And of course, the articlepoints out that the growth of
nurse practitioners issignificantly faster than the
growth of physicians.
In 2014, there was one nursepractitioner for every five
physicians, but just 10 yearslater, it was 1 to 2.
75.
And of course the number isgrowing by 45%.
(05:06):
So the article points out thatmany patients are receiving care
from nurse practitioners becauseof physician shortages, but also
because nurse practitioners areless expensive to hire and that
organizations are billinginsurances and patients for
their care at the same rate asphysician care.
(05:27):
So, then the article gets intowhat the training of nurse
practitioners are.
And the Bloomberg journalistsinterviewed a large number of
nurse practitioners across thecountry, and even some
educators.
And they raised very seriousconcerns about the education.
And this is echoing what What wehave shared here at the patients
(05:49):
at risk podcast, and in fact,some of the same people that
have appeared on our podcastwere interviewed for this
Bloomberg article.
The article points out that manynurse practitioners, even in
studies as recently as 2021found that new nurse
practitioner graduates feeluncertain.
They are doubting themselves andthat they feel minimally
(06:12):
prepared and caring for patientswith complex problems.
The article talks about howphysicians have been talking
about this, like myself and mycolleagues from Physicians for
Patient Protection, and,pointing out that the quality is
declining and it's not right forpatients to think that they're
(06:33):
seeing a physician because manynurse practitioners with
doctorates may call themselves adoctor.
And they point out in thisarticle that the response from
associations like the nursepractitioner organizations have
just said, well, this is just aturf war and that there's
nothing for patients to beworried about.
But, the article says that theytalked to nurse practitioners
(06:56):
who said that they wouldn'tentrust members of their own
families to be cared for by someof the new graduate nurse
practitioners that they'veobserved.
They also point out, as we have,that patients don't always know
how these nurse practitionersare trained.
They don't know.
where to look for thatinformation, and they don't know
(07:17):
how to make any complaintsagainst these nurse
practitioners.
For example, in the case of thepatient Fred Bedell, who died of
the diabetic ketoacidosis, theypoint out That the complaint
against the nurse practitionerwas filed two years after the
patient died and that thecomplaint did not disclose the
(07:37):
nurse practitioner's education,history, or even share the fact
that the patient had died.
The reporters actually had to doa lot of legwork and deep
investigation to figure out whatactually had happened.
So they point out that this isnot something that would be easy
for the public to ascertain atall.
(07:58):
The hospital spokesperson saidthat the nurse practitioner
stopped working at the facilitya few days later after the
patient was treated and thenurse practitioner did answer
the journalists in a textmessage saying that the incident
caused a lot of trauma, but thathe's moving forward in life just
(08:19):
fine.
And according to the article, Afinal order from Florida's
Department of Health in June of2023 assigned the nurse
practitioner 16 hours ofadditional education on critical
thinking and patient assessment.
And allowed him to keep hislicense.
So even though he made a mistakethat led to a patient death, the
(08:44):
recourse was 16 hours ofeducation.
Now they go on to talk aboutthat nurse practitioner's
education because it, it's animportant point that he didn't
know how to take care ofpatients because he received his
education mostly online.
He went to the University ofSouth Alabama, which I believe
(09:05):
is the same.
school that nurse practitionerAntoinette Thompson went to,
which was the nurse practitionerthat was involved in the death
of Alexis Ochoa that we talkabout in the book, Patients at
Risk.
And that, you know, that's notsurprising because that
university It says here awardedthe fifth largest number of
advanced nursing degrees in thecountry in 2022.
(09:28):
It has a 96 percent acceptancerate.
It gives out 800 master anddoctorate degrees of nursing
each year.
every year.
And if you attend that school,you only have to visit campus
one time.
And this particular nursepractitioner received a
doctorate in nursing practicewith a focus in emergency
(09:50):
medicine.
And so he was one of those fewthat was supposedly emergency
medicine certified working in anER, even though he did not
clearly know how to properlyDiagnose or Treat Diabetic
Ketoacidosis.
for this program, he was onlyrequired to go to campus twice
over two years for simulatedpatient encounters.
(10:14):
So having this type of trainingmay not be properly preparing
nurse practitioners and thearticle goes on to cite a few
other tragic cases.
One of a woman named TiffanyDunbar, who died while she was
vacationing in California froman ectopic pregnancy.
About two weeks before she died,the patient had been at a
(10:36):
woman's wellness center becauseshe was having some abdominal
discomfort and spotting, She wasseen by a nurse practitioner
with a master's degree from anonline program, the University
of Cincinnati, and I, it seemslike from the article that there
was concern that the patient hadan ectopic pregnancy, but the
(10:58):
nurse practitioner did not sharethat information with the
patient apparently becausequote, she saw no reason to
frighten Ms.
Dunbar with the prospect ofdying from an ectopic pregnancy.
So it seems like she told her tofollow up maybe for more lab
testing or an ultrasound, butdidn't tell her that she might
have or had an ectopicpregnancy.
(11:20):
The patient died of that ectopicThe article goes on to talk
about concerns about clinicalrotations, pointing out that
students only need 500 clinicalhours to graduate, which is less
than 5 percent of the amountthat physicians require before
we can practice medicine.
And they point out that thesepreceptorship hours are really
(11:42):
hard to get, that studentssometimes have to pay out of
pocket for them, and thatthey're really not standardized,
no one really knows exactly whatthe quality of that clinical
education is.
The article interviewed LindaSteele.
who is the former head of nursepractitioner programs at Walden
University, and she raisedconcerns about the placement of
(12:05):
students with preceptors thatshe felt were not the quality
that they should be.
Walden University is one ofthose programs that a lot of
people call a diploma millbetween that one and Chamberlain
University, which are both ownedby a publicly traded company
called AdTalem Global Education.
(12:28):
Those two programs gave out morethan 8,600 advanced nursing
degrees in 2022.
And the article points out thatthis for-profit company has made
a lot of money on their nursingprograms.
In fact, that company earned 1.
5 billion in 2023 Much of whichcame from its nursing degrees.
(12:54):
And they point out that thatAdTalum was a company that you
might have heard of beforebecause they used to be called
DeVry University.
The company changed its nameafter facing class action
lawsuits and investigations andthey actually paid a hundred
million dollars to the FederalTrade Commission in 2016 for
deceptive ads.
(13:14):
some of their programs weresuspended and they were facing a
bad reputation so they changedtheir name and now most people
have never heard of Ad Talum.
But they do own Chamberlain andWalden.
which, are producing many ofthese nurse practitioner
graduates.
The article interviewed multiplestudents who said that the
(13:35):
schools are not preparing themto practice.
There are allegations that thecompany is just taking student
money, giving out diplomas, butactually not doing what is
required to make sure that theirgraduates can adequately care
for patients.
Now, one of the interestingparts of this article is that
they talk about a preceptorclinic.
(13:58):
They use this as an example ofclinics across the country that
are receiving money throughthird party matchmaking services
to train nurse practitionerstudents.
And they reference this cliniccalled Mujtaba NP walk in clinic
in Clifton, New Jersey.
And it's really interestingbecause this is a clinic of
(14:19):
medical doctors that weretrained outside of the country,
so they don't have a license topractice medicine, but it seems
like they decided to becomenurse practitioners and got a
doctorate, so now they have aDNP degree.
And, according to this article,they initially called themselves
Doctor on their website, butthen after the journalists
(14:41):
contacted them to ask about it,they took that title off of
their website.
So the clinic does all sorts ofmedical treatments, but also
does, aesthetic treatments andother kind of alternative care.
This article Made it seem likethis clinic treated students
like labor and just asked themto start seeing patients, wanted
them to see as many patients aspossible in a short period of
(15:04):
time, and didn't actuallyprovide them with education or
training.
The article talked to severalnurse practitioners who were
speaking out about theirconcerns.
They interviewed Corey Hoska,who is an NP in Minnesota, who
said that a nurse practitionermade some sudden changes to his
(15:25):
mother's medicines that he saidcould have killed her, and that
his mom is just way toocomplicated to be cared for by a
nurse practitioner.
He even says that his degreefrom Purdue global.
Which was started by PurdueUniversity and then acquired by
a for profit school, KaplanUniversity, is not as rigorous
(15:48):
as he had hoped it would be, andhe says that he's worried about
nurse practitioners who are nowentering the system, saying,
quote, I personally know of twopeople who graduated
Chamberlain's online family NPprogram, Who I worked with as
bedside nurses that I wouldn'thave trusted to start an IV on
me, let alone be my provider.
(16:11):
The article also interviewedJohn Canyon, who you heard on
this podcast.
We'll link to that.
And he was also concernedbecause His father did not
receive proper care, in hisopinion, from two NPs, one at an
urgent care and then another onein an emergency department.
Anne Canyon talks about hisefforts to improve NP education.
(16:34):
And then, Raine Toman, who isnot a nurse practitioner, but is
a registered nurse, she sharedher story about leaving nurse
practitioner school because ofthe poor quality of education,
and she talks about therepercussions that she faced
when she voiced her concernsafter talking with our group,
Physicians for PatientProtection, noting that she was
(16:56):
told that she, quote, cavortswith our enemies and exhibits,
quote, frightening behavior justfor sharing her concerns.
so they have these anecdotes,but then the article also shares
the working paper from theNational Bureau of Economic
Research, which looked atemergency room treatment of
(17:16):
patients at the VeteransAdministration where nurse
practitioners are allowed topractice independently.
And they examined more than 1million patient records from 44
different emergency rooms andfound that the nurse
practitioners used moreresources and achieved less
favorable patient outcomes thanphysicians, including Increasing
(17:38):
the chances of preventablehospitalizations and doubling
the length of emergency roomstays the AANP dismissed that
working paper as an outlier.
They said it was still beingpeer reviewed.
So again, this was the first ina series of what I believe is
going to be three articles onnurse practitioner education.
(17:59):
And it took about a week, but itseems like the AANP finally did
produce a response to thearticle in a letter to the
editor for Bloomberg, currentAANP president Stephen Ferrara,
DNP, wrote a response.
(18:20):
I think it's interesting on juston a caveat, a lot of the people
speaking out and representingnurse practitioners are men.
And it's funny because it's beena, a woman dominated field for a
long time.
And in fact, when physiciansspeak out against nurse
practitioner, independentpractice, sometimes we're
accused of misogyny because it'sa more female dominated, whereas
(18:42):
physicians as a more maledominated profession.
But you can see, of course, thatthe tide is changing.
that women now are 50 percent ofmedical schools and increasingly
men are practicing as nursepractitioners.
So the current president is aman and He writes here that the
article, the Bloomberg article,the authors have failed to write
(19:03):
a balanced story by cherrypicking negative information and
failing to report the enormouscontributions nurse
practitioners make to patientcare and across the healthcare
system.
They say in this article thatthe authors have omitted the
fact that NPS have consistentlyrisen to meet our nation's
health care challenges.
(19:24):
Of course, talking about themstepping in during the pandemic
when they utilize thatopportunity to get unsupervised
practice in a number of states.
The AANP criticizes the authorsfor not including in the article
multiple studies that they sentto the authors saying that that
it demonstrated their highquality care.
(19:45):
I'm guessing they may not havebeen included because those
articles did not involveunsupervised nurse practitioners
because there are no articles orstudies on unsupervised nurse
practitioners.
The AANP cites the NationalAcademies of Science,
Engineering, and Medicine, whichis the previous Institute of
(20:06):
Medicine, which of course weknow has been a huge ally and
supporter of nursepractitioners.
The ANP cites several differentthink tanks including the
American Enterprise Instituteand the Brookings Institution,
sharing the same studies sayingthat they.
provide comparable care tophysicians, which of course, you
(20:27):
know, when you dig into them,again, these were studies of
nurse practitioners that wereworking with physicians under
physician supervision or caringfor lower risk patients almost
every single time.
They claim that there are,there's no evidence of harm to
patients but the truth is thatreally hasn't been evaluated.
(20:50):
There have not been anyrandomized trials.
The truth is we really don'tknow.
We haven't actually examinedunsupervised care.
The AANP says that Nursepractitioner programs are
nationally accredited and thatthey're held responsible to the
Department of Education.
(21:10):
They say that the clinicalrotations must adhere to
accreditation standards.
So they say all of these things,but But yet the article points
out that that is not what isactually happening.
So it's really disappointingthat the AANP doesn't take
seriously the concerns that arebeing pointed out by NPs and by
NP students to say, Hey, youknow, maybe instead of being
(21:33):
defensive, maybe we shouldactually look at what's
happening and see if we can fixit and improve our education.
So ultimately the articleconcludes generalizations
sensationalism and cherrypicking should not be used by
news sources to disparage NPs orother professions that are
caring for patients and theirfamilies throughout the nation.
(21:55):
And this is the usual mantrathat we hear instead of taking
seriously concerns about patientsafety, there's just
defensiveness, accusations, andgaslighting basically of These
journalists, I just have toapplaud them so much for their
bravery in speaking out aboutthis because I'm sure you'll see
(22:17):
comments if you go to thedifferent Bloomberg posts on
Instagram, Facebook, Twitter,that lots of of NPs and
advocates are piling on sayingthat it's unfair, that it's
biased, but also you'll see alot of comments by NPs who are
totally agreeing and with whatthis article is pointing out.
(22:39):
So I'm looking forward to seeingwhat the next two articles
bring.
I also want to let you know thatPhysicians for Patient
Protection was definitelyinvolved to a certain extent in
this article in that several ofour board members spoke with the
journalists to give thembackground information, provided
them with resources.
And it's really gratifying toknow that these really diligent
(23:03):
investigators, you know, they'renot just going to listen to us
and take our word for it.
They listen to what we had tosay, but then they did their own
investigation and they dove intothese stories and the data and
the literature.
And these are their conclusions.
It's not, they're not justrepeating our talking points.
They have mounted their ownconcerns, and I think they're
(23:25):
very valid concerns from anyonethat is a patient or will be a
patient, which is all of us.
We need to make sure thatwhoever is providing our care is
properly trained, properlyeducated, and it's not just
about access, it's about accessto quality care.
Thanks so much for listening.
(23:45):
I'll come back and share withyou the future articles.
I hope that you'll check themout.
If you've enjoyed this podcastand you'd like to learn more
about this topic, pleaseconsider getting the books
Patients at Risk and ImposterDoctors.
They're available on Amazon andat barnesandnoble.
com.
We also have them in an audibleversion.
(24:06):
If you're a physician and you'dlike to help support our work to
ensure physician-led care forall patients and truth and
transparency among healthcarepractitioners, then I would love
for you to join our group.
It's called Physicians forPatient Protection.
You can learn more at ourwebsite, physicians for patient
protection.org.
Thanks so much and we'll see youon the next podcast.
Welcome to Patients at Risk, adiscussion of the dangers that
patients face when physiciansare replaced with non physician
practitioners.
I'm your host and the co authorof the book, Patients at Risk,
and the author of the follow upbook, Impostor Doctors.
Rebecca Bernard.
Today, I'm sharing a breakingarticle from Bloomberg Business
(00:28):
by investigative journalistCaleb Melby and colleagues, and
it's called The Miseducation ofAmerica's Nurse Practitioners.
Was published just this lastweek, and I'll share the link in
the podcast notes.
Now we first learned about CalebMelby when it comes to nurse
practitioners, because he wasone of the investigative
(00:51):
journalists researching thecompany Cerebral and others like
that.
There was another one calledDunn and various others.
That really became prominentduring the COVID 19 pandemic,
especially during stay at homeorders.
And these companies wereoffering at home mental health
care.
And in particular, they wereoffering controlled substance
(01:15):
medications for ADD and led to areally significant rise in the
number of stimulantprescriptions.
So Melby and his colleagueswrote some articles that
basically discussed concernsabout this rise in these
medications, the potentialimpact on patients.
Perhaps that work led to some ofwhat we're seeing now, which is
(01:39):
that the CEO of Dunn wasactually arrested along with the
company's clinical president forfraud, because they provided
easy access to stimulants likeAdderall and Ritalin over the
internet, For monthlysubscription fees.
And of course, these companiesalmost exclusively hired nurse
(02:03):
practitioners and notphysicians.
So Caleb Melby and hiscolleagues at Bloomberg,
apparently this raised somealarms to them.
Why are there so many nursepractitioners working for these
companies?
I did receive an email from Mr.
Melby in December of last year.
that he had actually gotten acopy of Patients at Risk and was
(02:26):
reading it and really interestedin the topic and wanted to
explore this significant growthin nurse practitioners.
So just this last week,published the first in what is
going to be a series on nursepractitioners.
And the first article was titledthe Miseducation of America's
(02:46):
Nurse Practitioners.
And the title says they don'tmerely support doctors.
NPs increasingly treat patientsindependently, including in
specialty practices andemergency rooms.
When they aren't well trained,the results can be tragic.
And this article shares.
Stories and Anecdotes ofPatients That Were Harmed by
(03:09):
Improperly Trained NursePractitioners.
For example, the first storythey share is the story of Fred
Bedell.
He went into an emergencydepartment in 2020 with severe
abdominal pain.
And he, of course, as we areseeing increasingly, did not
receive care from an emergencyphysician or even any medical
(03:32):
doctor.
In fact, he was cared for by anurse practitioner who had just
received his license four monthsprior The nurse practitioner
found that the patient's bloodsugar was nearly 600.
And of course that should haverequired admission, but he
decided to send the patient homewhere he died of diabetic
(03:55):
ketoacidosis.
So the article cites asettlement from the hospital
company, which was HCAHealthcare, One of the largest
for profit health systems in thecountry the settlement paid out
750, 000.
The article says that the familymembers can't discuss the case
because of that payout, but theinvestigators on their review,
(04:19):
Cannot see any evidence that aphysician, was ever involved in
the care of the patient.
Now, the article points out thatthis is not unusual, that there
are now they say more than300,000 nurse practitioners, but
actually the A A NP.
In their most recent article ontheir website says that there
are 385, 000 nurse practitionersnow.
(04:43):
And of course, the articlepoints out that the growth of
nurse practitioners issignificantly faster than the
growth of physicians.
In 2014, there was one nursepractitioner for every five
physicians, but just 10 yearslater, it was 1 to 2.
75.
And of course the number isgrowing by 45%.
(05:06):
So the article points out thatmany patients are receiving care
from nurse practitioners becauseof physician shortages, but also
because nurse practitioners areless expensive to hire and that
organizations are billinginsurances and patients for
their care at the same rate asphysician care.
(05:27):
So, then the article gets intowhat the training of nurse
practitioners are.
And the Bloomberg journalistsinterviewed a large number of
nurse practitioners across thecountry, and even some
educators.
And they raised very seriousconcerns about the education.
And this is echoing what What wehave shared here at the patients
(05:49):
at risk podcast, and in fact,some of the same people that
have appeared on our podcastwere interviewed for this
Bloomberg article.
The article points out that manynurse practitioners, even in
studies as recently as 2021found that new nurse
practitioner graduates feeluncertain.
They are doubting themselves andthat they feel minimally
(06:12):
prepared and caring for patientswith complex problems.
The article talks about howphysicians have been talking
about this, like myself and mycolleagues from Physicians for
Patient Protection, and,pointing out that the quality is
declining and it's not right forpatients to think that they're
(06:33):
seeing a physician because manynurse practitioners with
doctorates may call themselves adoctor.
And they point out in thisarticle that the response from
associations like the nursepractitioner organizations have
just said, well, this is just aturf war and that there's
nothing for patients to beworried about.
But, the article says that theytalked to nurse practitioners
(06:56):
who said that they wouldn'tentrust members of their own
families to be cared for by someof the new graduate nurse
practitioners that they'veobserved.
They also point out, as we have,that patients don't always know
how these nurse practitionersare trained.
They don't know.
where to look for thatinformation, and they don't know
(07:17):
how to make any complaintsagainst these nurse
practitioners.
For example, in the case of thepatient Fred Bedell, who died of
the diabetic ketoacidosis, theypoint out That the complaint
against the nurse practitionerwas filed two years after the
patient died and that thecomplaint did not disclose the
(07:37):
nurse practitioner's education,history, or even share the fact
that the patient had died.
The reporters actually had to doa lot of legwork and deep
investigation to figure out whatactually had happened.
So they point out that this isnot something that would be easy
for the public to ascertain atall.
(07:58):
The hospital spokesperson saidthat the nurse practitioner
stopped working at the facilitya few days later after the
patient was treated and thenurse practitioner did answer
the journalists in a textmessage saying that the incident
caused a lot of trauma, but thathe's moving forward in life just
(08:19):
fine.
And according to the article, Afinal order from Florida's
Department of Health in June of2023 assigned the nurse
practitioner 16 hours ofadditional education on critical
thinking and patient assessment.
And allowed him to keep hislicense.
So even though he made a mistakethat led to a patient death, the
(08:44):
recourse was 16 hours ofeducation.
Now they go on to talk aboutthat nurse practitioner's
education because it, it's animportant point that he didn't
know how to take care ofpatients because he received his
education mostly online.
He went to the University ofSouth Alabama, which I believe
(09:05):
is the same.
school that nurse practitionerAntoinette Thompson went to,
which was the nurse practitionerthat was involved in the death
of Alexis Ochoa that we talkabout in the book, Patients at
Risk.
And that, you know, that's notsurprising because that
university It says here awardedthe fifth largest number of
advanced nursing degrees in thecountry in 2022.
(09:28):
It has a 96 percent acceptancerate.
It gives out 800 master anddoctorate degrees of nursing
each year.
every year.
And if you attend that school,you only have to visit campus
one time.
And this particular nursepractitioner received a
doctorate in nursing practicewith a focus in emergency
(09:50):
medicine.
And so he was one of those fewthat was supposedly emergency
medicine certified working in anER, even though he did not
clearly know how to properlyDiagnose or Treat Diabetic
Ketoacidosis.
for this program, he was onlyrequired to go to campus twice
over two years for simulatedpatient encounters.
(10:14):
So having this type of trainingmay not be properly preparing
nurse practitioners and thearticle goes on to cite a few
other tragic cases.
One of a woman named TiffanyDunbar, who died while she was
vacationing in California froman ectopic pregnancy.
About two weeks before she died,the patient had been at a
(10:36):
woman's wellness center becauseshe was having some abdominal
discomfort and spotting, She wasseen by a nurse practitioner
with a master's degree from anonline program, the University
of Cincinnati, and I, it seemslike from the article that there
was concern that the patient hadan ectopic pregnancy, but the
(10:58):
nurse practitioner did not sharethat information with the
patient apparently becausequote, she saw no reason to
frighten Ms.
Dunbar with the prospect ofdying from an ectopic pregnancy.
So it seems like she told her tofollow up maybe for more lab
testing or an ultrasound, butdidn't tell her that she might
have or had an ectopicpregnancy.
(11:20):
The patient died of that ectopicThe article goes on to talk
about concerns about clinicalrotations, pointing out that
students only need 500 clinicalhours to graduate, which is less
than 5 percent of the amountthat physicians require before
we can practice medicine.
And they point out that thesepreceptorship hours are really
(11:42):
hard to get, that studentssometimes have to pay out of
pocket for them, and thatthey're really not standardized,
no one really knows exactly whatthe quality of that clinical
education is.
The article interviewed LindaSteele.
who is the former head of nursepractitioner programs at Walden
University, and she raisedconcerns about the placement of
(12:05):
students with preceptors thatshe felt were not the quality
that they should be.
Walden University is one ofthose programs that a lot of
people call a diploma millbetween that one and Chamberlain
University, which are both ownedby a publicly traded company
called AdTalem Global Education.
(12:28):
Those two programs gave out morethan 8,600 advanced nursing
degrees in 2022.
And the article points out thatthis for-profit company has made
a lot of money on their nursingprograms.
In fact, that company earned 1.
5 billion in 2023 Much of whichcame from its nursing degrees.
(12:54):
And they point out that thatAdTalum was a company that you
might have heard of beforebecause they used to be called
DeVry University.
The company changed its nameafter facing class action
lawsuits and investigations andthey actually paid a hundred
million dollars to the FederalTrade Commission in 2016 for
deceptive ads.
(13:14):
some of their programs weresuspended and they were facing a
bad reputation so they changedtheir name and now most people
have never heard of Ad Talum.
But they do own Chamberlain andWalden.
which, are producing many ofthese nurse practitioner
graduates.
The article interviewed multiplestudents who said that the
(13:35):
schools are not preparing themto practice.
There are allegations that thecompany is just taking student
money, giving out diplomas, butactually not doing what is
required to make sure that theirgraduates can adequately care
for patients.
Now, one of the interestingparts of this article is that
they talk about a preceptorclinic.
(13:58):
They use this as an example ofclinics across the country that
are receiving money throughthird party matchmaking services
to train nurse practitionerstudents.
And they reference this cliniccalled Mujtaba NP walk in clinic
in Clifton, New Jersey.
And it's really interestingbecause this is a clinic of
(14:19):
medical doctors that weretrained outside of the country,
so they don't have a license topractice medicine, but it seems
like they decided to becomenurse practitioners and got a
doctorate, so now they have aDNP degree.
And, according to this article,they initially called themselves
Doctor on their website, butthen after the journalists
(14:41):
contacted them to ask about it,they took that title off of
their website.
So the clinic does all sorts ofmedical treatments, but also
does, aesthetic treatments andother kind of alternative care.
This article Made it seem likethis clinic treated students
like labor and just asked themto start seeing patients, wanted
them to see as many patients aspossible in a short period of
(15:04):
time, and didn't actuallyprovide them with education or
training.
The article talked to severalnurse practitioners who were
speaking out about theirconcerns.
They interviewed Corey Hoska,who is an NP in Minnesota, who
said that a nurse practitionermade some sudden changes to his
(15:25):
mother's medicines that he saidcould have killed her, and that
his mom is just way toocomplicated to be cared for by a
nurse practitioner.
He even says that his degreefrom Purdue global.
Which was started by PurdueUniversity and then acquired by
a for profit school, KaplanUniversity, is not as rigorous
(15:48):
as he had hoped it would be, andhe says that he's worried about
nurse practitioners who are nowentering the system, saying,
quote, I personally know of twopeople who graduated
Chamberlain's online family NPprogram, Who I worked with as
bedside nurses that I wouldn'thave trusted to start an IV on
me, let alone be my provider.
(16:11):
The article also interviewedJohn Canyon, who you heard on
this podcast.
We'll link to that.
And he was also concernedbecause His father did not
receive proper care, in hisopinion, from two NPs, one at an
urgent care and then another onein an emergency department.
Anne Canyon talks about hisefforts to improve NP education.
(16:34):
And then, Raine Toman, who isnot a nurse practitioner, but is
a registered nurse, she sharedher story about leaving nurse
practitioner school because ofthe poor quality of education,
and she talks about therepercussions that she faced
when she voiced her concernsafter talking with our group,
Physicians for PatientProtection, noting that she was
(16:56):
told that she, quote, cavortswith our enemies and exhibits,
quote, frightening behavior justfor sharing her concerns.
so they have these anecdotes,but then the article also shares
the working paper from theNational Bureau of Economic
Research, which looked atemergency room treatment of
(17:16):
patients at the VeteransAdministration where nurse
practitioners are allowed topractice independently.
And they examined more than 1million patient records from 44
different emergency rooms andfound that the nurse
practitioners used moreresources and achieved less
favorable patient outcomes thanphysicians, including Increasing
(17:38):
the chances of preventablehospitalizations and doubling
the length of emergency roomstays the AANP dismissed that
working paper as an outlier.
They said it was still beingpeer reviewed.
So again, this was the first ina series of what I believe is
going to be three articles onnurse practitioner education.
(17:59):
And it took about a week, but itseems like the AANP finally did
produce a response to thearticle in a letter to the
editor for Bloomberg, currentAANP president Stephen Ferrara,
DNP, wrote a response.
(18:20):
I think it's interesting on juston a caveat, a lot of the people
speaking out and representingnurse practitioners are men.
And it's funny because it's beena, a woman dominated field for a
long time.
And in fact, when physiciansspeak out against nurse
practitioner, independentpractice, sometimes we're
accused of misogyny because it'sa more female dominated, whereas
(18:42):
physicians as a more maledominated profession.
But you can see, of course, thatthe tide is changing.
that women now are 50 percent ofmedical schools and increasingly
men are practicing as nursepractitioners.
So the current president is aman and He writes here that the
article, the Bloomberg article,the authors have failed to write
(19:03):
a balanced story by cherrypicking negative information and
failing to report the enormouscontributions nurse
practitioners make to patientcare and across the healthcare
system.
They say in this article thatthe authors have omitted the
fact that NPS have consistentlyrisen to meet our nation's
health care challenges.
(19:24):
Of course, talking about themstepping in during the pandemic
when they utilize thatopportunity to get unsupervised
practice in a number of states.
The AANP criticizes the authorsfor not including in the article
multiple studies that they sentto the authors saying that that
it demonstrated their highquality care.
(19:45):
I'm guessing they may not havebeen included because those
articles did not involveunsupervised nurse practitioners
because there are no articles orstudies on unsupervised nurse
practitioners.
The AANP cites the NationalAcademies of Science,
Engineering, and Medicine, whichis the previous Institute of
(20:06):
Medicine, which of course weknow has been a huge ally and
supporter of nursepractitioners.
The ANP cites several differentthink tanks including the
American Enterprise Instituteand the Brookings Institution,
sharing the same studies sayingthat they.
provide comparable care tophysicians, which of course, you
(20:27):
know, when you dig into them,again, these were studies of
nurse practitioners that wereworking with physicians under
physician supervision or caringfor lower risk patients almost
every single time.
They claim that there are,there's no evidence of harm to
patients but the truth is thatreally hasn't been evaluated.
(20:50):
There have not been anyrandomized trials.
The truth is we really don'tknow.
We haven't actually examinedunsupervised care.
The AANP says that Nursepractitioner programs are
nationally accredited and thatthey're held responsible to the
Department of Education.
(21:10):
They say that the clinicalrotations must adhere to
accreditation standards.
So they say all of these things,but But yet the article points
out that that is not what isactually happening.
So it's really disappointingthat the AANP doesn't take
seriously the concerns that arebeing pointed out by NPs and by
NP students to say, Hey, youknow, maybe instead of being
(21:33):
defensive, maybe we shouldactually look at what's
happening and see if we can fixit and improve our education.
So ultimately the articleconcludes generalizations
sensationalism and cherrypicking should not be used by
news sources to disparage NPs orother professions that are
caring for patients and theirfamilies throughout the nation.
(21:55):
And this is the usual mantrathat we hear instead of taking
seriously concerns about patientsafety, there's just
defensiveness, accusations, andgaslighting basically of These
journalists, I just have toapplaud them so much for their
bravery in speaking out aboutthis because I'm sure you'll see
(22:17):
comments if you go to thedifferent Bloomberg posts on
Instagram, Facebook, Twitter,that lots of of NPs and
advocates are piling on sayingthat it's unfair, that it's
biased, but also you'll see alot of comments by NPs who are
totally agreeing and with whatthis article is pointing out.
(22:39):
So I'm looking forward to seeingwhat the next two articles
bring.
I also want to let you know thatPhysicians for Patient
Protection was definitelyinvolved to a certain extent in
this article in that several ofour board members spoke with the
journalists to give thembackground information, provided
them with resources.
And it's really gratifying toknow that these really diligent
(23:03):
investigators, you know, they'renot just going to listen to us
and take our word for it.
They listen to what we had tosay, but then they did their own
investigation and they dove intothese stories and the data and
the literature.
And these are their conclusions.
It's not, they're not justrepeating our talking points.
They have mounted their ownconcerns, and I think they're
(23:25):
very valid concerns from anyonethat is a patient or will be a
patient, which is all of us.
We need to make sure thatwhoever is providing our care is
properly trained, properlyeducated, and it's not just
about access, it's about accessto quality care.
Thanks so much for listening.
(23:45):
I'll come back and share withyou the future articles.
I hope that you'll check themout.
If you've enjoyed this podcastand you'd like to learn more
about this topic, pleaseconsider getting the books
Patients at Risk and ImposterDoctors.
They're available on Amazon andat barnesandnoble.
com.
We also have them in an audibleversion.
(24:06):
If you're a physician and you'dlike to help support our work to
ensure physician-led care forall patients and truth and
transparency among healthcarepractitioners, then I would love
for you to join our group.
It's called Physicians forPatient Protection.
You can learn more at ourwebsite, physicians for patient
protection.org.
Thanks so much and we'll see youon the next podcast.
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