[NPInfo] Re: Jeffs letter

Mon Sep 3 10:22:43 PDT 2007

Jeff and Dave--
Agree with everything you have both pointed out. I think those disagreeing
with Jeff's letter are definitely missing the BIG picture here. If they read
all the articles and editorials by MDs complaining about the spreading of
the retail clinics, they ALL go out of their way to mention somewhere that
the clinics are staffed by NP/PAs and bring up the question of the safety
and quality of care since we aren't being "supervised" by MDs. The clinics
owned by MDs are apparently fine, even if they also employ NPs/PAs to see
patients without a MD actually on the premises, so obviously the AMA doesn't
REALLY have a problem with the qualifications, performance, or safety of
NPs/PAs-- just the fact that the MDs aren't in control of us or making money
off of us. It's all about control and money. And with these clinics, the MDs
have neither. Very simple to read between their lines. Even I was able to
catch it <G>.
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of David Mittman
Sent: Monday, September 03, 2007 9:35 AM
To: NPinfo
Subject: Re: [NPInfo] Re: Jeffs letter

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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