[NPInfo] Re: Jeffs letter

Mon Sep 3 09:34:33 PDT 2007

Carla: Agree with much of what you said. The part I do not is that is has
little to do with the fact that these clinics are staffed by us. On the one
hand it does very much because we can be easily attacked, on the other if
docs owned them, it would be economically fine for the AMA.
The Urgent Care centers which strung up in the early 90s did the same thing
to a much larger degree. They also said they could serve as your medical
home especially if you were young and healthy. They were owned by docs and
staffed by docs, PAs and NPs. There are still a number of successful ones
around. Many are staffed only by us.
Were they ever attacked for their quality of care? Were they ever held to
the scrutiny that the retail clinics are? Most importantly were the NPs and
PAs who work in these attacked in a massive PR campaign as the AMA is doing
now? I do not remember everything from those years anymore but I think not.
Why? Reason is they were owned by members of the club and now they will be
owned by big business. The motto has always been, keep the money in the
house. The docs don't want to lose much more ground in their lives
generally, especially to big business. So they attack the weakest link,
first they did the "you have to walk through the pharmacy" routine and that
didn't work, so now they are doing "the NP will miss things and people will
be hurt" routine and that too does not seem to be working. We are pawns in
the middle of this and as you said it is Mothera versus Godzilla for a nice
slice of the future finances that will be spent on this.
Dave

 routine. On 9/3/07 2:18 AM, "Carla Anderson" <carla_rayne at yahoo.com> wrote:

> Jeff,
>  
> You are coming across as patronizing. I am sure you dont mean to.  We all have
> been saying for a long time that it is obvious that the real core of the issue
> is not the care NPs and PAs give, it is about the money. You are preaching to
> the choir about the doctors complaints ringing hollow. We know they cannot say
> what they are really feeling.  But I disagree, I do not think it can be
> simplified down to big business stealing the golden goose. That is for one
> thing selling us short that we can be bought so easily.  First of all,
> everyone is some sense is a commodity. It is a matter of choice where you want
> to be a commodity and if it is a good fit.  We as NPs and PAs make personal
> choices, whether it be to work in our own practice, starting at poverty levels
> to try and be our own boss and deliver care the way we have always wanted to,
> or whether we want to work in a physicians office, or whether we want to go
> work in a drug store. Who cares? We are not being stolen away. We
> are choosing. The hardest part for us is making a choice based on information
> given to us that may not be honestly portrayed, even with the best question
> asking, that is why a written contract should be in place, and regarding the
> drug store jobs, reading Tracy's article AGAIN would be very helpful to assist
> our choice at least not being a surprise.  I do think it is about money, but I
> think it is also about patient choice, and the physicians are mad simply
> because patients have more choice, in other words we are back to the concept
> of more competition, and yes it is childish, and the higher road would be to
> be happy that there is an alternative for patients if the provider is truly in
> medicine for altruistic reasons, but no, so much is about money, and this is
> potentially hitting pockets in a big big way.  If the retail clinics did not
> exist, those patients with the ear infections, and bladder infections and
> rashes would have to pick up the phone and go to their doctors
> office, and maybe wait a few days, and now those doctors are losing that
> segment of the population.  And yes it is being rubbed in their faces because
> there are commercials, and ads in AARP, and in the many newspapers, but it is
> not so much who is giving the care, it could be all docs working in those
> clinics.  So lets take your commodity on the shelf analogy, instead of US
> being offered on another shelf at a cheaper price, I say the issue is that
> patients just have MORE ITEMS on the shelf to choose from, and they dont care
> what big or small businesses put them there, just that they have more choice.
> So it is about supply and demand, but the supply is not the NPs, it is the
> access to care, and points of care.  Just like now there is a clinic in an
> airport, with doctors as investors.  I am sure if the airports all started
> popping up clinics with doctors staffing them, the docs in the regular offices
> would be upset about that too, because it would be taking away their
> potential business...and those clinics might be privately owned, not by big
> business, and might be physician staffed, so again the issue is not the NP or
> PA or big business but the decrease in demand for their services, just like
> the housing market. The answer is for these docs is either start their own, or
> make their own existing practice more like what is attractive about the retail
> clinics- open more hours, lower prices, no waiting for appt dates, close
> locations to pharmacies, or quick faxing or call ins. Of course that would be
> a great improvement, as rising to the highest level would be good for
> healthcare, but they still cannot replace or ever become what a Nurse
> Practitioner offers, that unique blend of nursing and medical provider care.
> That is my opinion, Carla/Oregon.
> 
> Jeffrey Hazzard <jeffnp27 at yahoo.com> wrote:
> Tracy,
> 
> No, I think that is EXACTLY the point. The doctors don't have any objection
> until the money for our labor is taken out of their pockets and put in the
> pockets of big business. Big business has found an innovative way to cut the
> doctors out and they are ticked off about it. They can't fight back in any
> manner except to cast doubt about us.
> 
> Think of us as a commodity if it will help you. Imagine that we are a product
> on the shelf in the doctors' offices that only they are allowed to sell. Now
> imagine that another business puts the same product on its shelf at a cheaper
> price. Our situation is similar, and it is as if the doctors are saying the
> product which they promoted when they owned it is now second-rate and not to
> be trusted.
> 
> The point I've made is NOT that we are setting up independent practices. The
> point is that we are functioning in a dependent employee situation analogous
> to the ones we held in a doctor's office. The point I've made is that the
> docs' complaints ring hollow because they are only making the complaints when
> we are no longer profitable to them; our profits are now going to big
> corporations. Doctors complain about quality of care because they can't say,
> "We're pissed off because Wal-Mart stole our golden gooses."
> 
> The issue has never been the care we provide. It is about who makes money from
> our labors. It is like we are this precious profit center now being struggled
> over by a clash of titans. We want the corporates to win because it will
> eventually lead to our autonomy. The docs are scared. They are angry. They are
> losing profits AND that profit source is going to compete with them directly.
> But they can't say that, of course, so we must say it for them!
> 
> Jeff
> 
> Tracy Klein wrote:
> 
>> Jeff.
> I was right there with you up until the point of taking the profit
> and giving it to a large corporation being linked to us being
> "independent".
> They are two entirely different issues, socioeconomically and
> politically.
> Unless of course, you own the corporation. Which is still illegal for
> NPs, in many states.
> Tracy Klein, WHCNP, FNP
> Portland, Oregon
>> ------------------------------
>> 
>> Message: 10
>> Date: Sun, 2 Sep 2007 17:27:37 -0700 (PDT)
>> From: Jeffrey Hazzard
>> Subject: Re: [NPInfo] Re: NPInfo Digest, Vol 18, Issue 4
>> To: NP Info 
>> Message-ID: <962214.24963.qm at web31309.mail.mud.yahoo.com>
>> Content-Type: text/plain; charset=iso-8859-1
>> 
>> Tracy,
>> This is not about indentured servitude in a doctor's office.
>> This is about them restricting us being independent, and about
>> their besmurching our name unfairly. It is bad enough that they
>> are profiteering with us in a dependent posture, but now to
>> actively campaign against us coming into our own in a role that
>> will make us marketable goes too far. They love us, so long as we
>> are making them a profit. Take that profit and give it to a large
>> corporation (CVS, Wal-Mart) and we are no longer safe, effective,
>> or competent. DISGUSTING.
>> Respectfully, I would emphatically repeat my thinking here
>> that we must get to the matter....that we expose the doctors for
>> their true motivation and not let them misrepresent their
>> objections to us to the press and the public. The doctors are
>> blatantly using the public's trust in them to keep the public from
>> getting competent, cost effective care. We can't sit still while
>> this happens, and we can't sugar coat it. Remember, American
>> newspapers are written on an 8th grade reading level. We have to
>> confront them on all these practices or we will be back in the
>> handmaiden box again.
>> WAKE UP ALL OF YOU AND GET SNAPPING. OUR PROFESSIONAL
>> FUTURE IS ON THE LINE.
>> 
>> Jeff
>> 
>> Tracy Klein wrote:
>> 
>> Choose your favorite NP outcome study to insert into
>> Jeff's letter:
>> http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3321.
>> Or better yet, conduct your own...
>> Please, however, move beyond why doctors are doing
>> this or why its not fair. Prove it and call it what it
>> is. Learn how to figure out how much you are
>> contributing to their bottom line.
>> Tracy Klein, MS, WHCNP, FNP
>> Portland, Oregon
>> 
>> ___________________________________________________
>> Message: 2
>> Date: Sun, 2 Sep 2007 04:30:39 -0700 (PDT)
>> From: Jeffrey Hazzard
>> Subject: [NPInfo] Jeff's answer to doctor attacks
>> To: npinfo npinfo , ACC Listserv
>> 
>> Cc: SGrtWhite at aol.com
>> Message-ID:
>> <971290.48063.qm at web31304.mail.mud.yahoo.com>
>> Content-Type: text/plain; charset=iso-8859-1
>> 
>> Steve,
>> 
>> [ Here's what I'd say. I tried to prioritize, so
>> that if you can
>> only say some of it, the points are in descending
>> order of importance.
>> The last tag line in the last paragraph should be
>> said last in any
>> interview. This is the written form. If it is
>> spoken in a soundbite, it
>> should be said a lot less formally, or it will come
>> out sounding as
>> though it is being read aloud. ]
>> 
>> "The doctors are running scared. Their fear,
>> however, is for
>> their pocketbooks, not their patients. ALL evidence,
>> including a large
>> study by the Federal Government Accountability Office
>> (GAO) and another
>> head to head prospective, randomized clinical trial
>> published in
>> ____________(either JAMA?? or NEJM??) each strongly
>> concluded that NPs and
>> PAs provide safe, comprehensive care comparable to
>> that of a doctor, and
>> at lower cost. For doctors to say that patients are
>> placed at risk
>> when they are cared for by a NP or PA is not accurate
>> and smacks of turf
>> protection and scare-mongering, not scientific
>> reality.
>> 
>> "In more than 15 states NPs practice
>> INDEPENDENTLY (no
>> relationship to a doctor at all) providing all
>> aspects of primary care. Most
>> rural NPs and PAs function autonomously in clinics
>> without a physician
>> present. Both professionals are usually the only one
>> in a patient room
>> synthesizing myriad data and health parameters to
>> diagnose and
>> prescribe diagnostic tests and medications
>> INDEPENDENTLY. Rates of patient
>> satisfaction, health statistics, and malpractice
>> rates in primary care are
>> at least as good, and sometimes BETTER, for NPs and
>> PAs when compared
>> to doctors.
>> 
>> "Doctors pride themselves at employing scientific
>> method in an
>> evidenced-based practice. All evidence would show
>> that spokesperson
>> doctors representing professional organizations are
>> willing to part from
>> scientific data when their long-held monopoly on
>> power and money are at
>> risk.
>> 
>> "We are now hearing a lot about NPs and PAs
>> because they are
>> individually visible, employed in places like retail
>> clinics and
>> community-based offices. Doctors never objected to
>> NPs and PAs working in clinics
>> by themselves at health departments, migrant health
>> clinics, urban
>> ghetto outreach clinics for the poor, or in public
>> school systems.
>> Doctors only started thinking about 'patient safety'
>> when those patients had
>> health insurance and the ability to pay."
>> 
>> "When doctors try to limit the medical practice of
>> NPs and PAs they
>> are directly hurting the public. One out of six
>> Americans has no
>> health insurance. We have a shortage of health care
>> providers that is
>> rapidly growing worse. It is time for doctors to put
>> the American public
>> ahead of their own interests. It is time for them to
>> back off and
>> realize that NPs and PAs are not nearly as large a
>> threat to their incomes
>> and power as having all Americans realize trust
>> placed in doctors has
>> been violated by the doctors themselves."
>> 
>> Jeff
>> 
>> 
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>> 
>> 
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>> ------------------------------
>> 
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>> End of NPInfo Digest, Vol 18, Issue 6
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> 
> Carla R. Anderson, FNP-C
> Healing Presence Family Practice, PC
> carla_rayne at yahoo.com
> 503 819 9726
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