Disclaimer: I don't post here often, but I'm trying to get some traction going on awareness of this issue anywhere along the political spectrum I can.

There are a lot of times I do not agree with this board, there are a lot of times I do agree with this board. However there is one battle I don't see being picked up by Republicans, and if they did it would be a massive voting block for them.

That is physicians, nurses, and to extent many of the mid-level providers bills like these are about. As well as regular working class Americans across the board.

WHAT IS THIS ABOUT?

There is currently a major battle going on in Healthcare on whether mid-level providers (Nurse Practitioners, Physician Assistants) should be allowed to practice independently after graduating their respective institutions. Many states have allowed this with minor supervision, some with absolutely no supervision.

The most recent battle being that in South Dakota. Listen to testimonies (including AMA President Dr. Susan Bailey @ 37 min) against AAPA’s South Dakota House Bill 1163 that gives P. Assistants the right to practice medicine independently after 520 clinical hours: https://sdpb.sd.gov/SDPBPodcast/2021/hhe22.mp3

WHAT WAS THE ORIGINAL INTENT?

Originally the claim was these mid-level providers have less debt, and more willingness to go to low COL and socioeconomic areas to serve them, mostly rural areas.

This hasn't really been the case. Like other health professionals (MD/DOs) people elect to stay in popular areas because they are... popular.

WHY IS THIS A PROBLEM?

What has started to occur are NP/PAs practicing far outside of their scope.

We have issues of patients dying during routine colonoscopies: https://www.deadlinedetroit.com/articles/27205/starkman_beaumont_hospital_staffers_horrified_after_patient_dies_during_routine_colonoscopy

NPs setting up ketamine clinics to make quick cash: https://www.reddit.com/gallery/lkedyx

NP Diploma mills that are almost entirely online, and not only have no requirements for RN experience, but nearly 100% admit rates with unsupervised "reported" hours for completion of the degree: https://www.physiciansforpatientprotection.org/nurse-practitioner-diploma-mills-not-the-answer-to-physician-shortage/

WHAT DOES RESEARCH SAY?

There is a lot of literature on this, most of the decent science was not funded and paid for by AANP (NP society).

Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/

Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082

Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374

Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696

The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract00732-5/abstract)

Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/

NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/

(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625

NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/

WHY YOU SHOULD CARE?

This impacts you. All of you. Yes personally I am a physician, and I will face direct impact from this, but more than that my patients will. I'm smart enough to advocate for myself when I am on the patient side, and still my father was nearly left to die by one of these NPs practicing at an "Urgent Care" who didn't bother to get the doctor to see him. He's extraordinarily lucky.

This is what happens when inadequately trained professionals try to play doctor: https://www.youtube.com/watch?v=vhHDm4UYHs0&t=39s

I have seen things like this. You want to know the core of the psychiatric drug crisis? Why everyone is being put on massive amounts of meds? That's mostly thanks to PMHNPs (the psych version of NPs), and on my psychology rotation we had multiple cases of referrals from NP treated patients who had psych med lists longer than my arm, even on children no less.

So it affects your kids too. Your loved ones. At the end of the day it creates a 2-tiered health system, where anyone on medicare/aid will be the ones subject to all of this.

These midlevels are graduating with less average hours trained than police officers: https://i.redd.it/cugrt5qfopn51.jpg

4th year medical students have more training then midlevels, nearly 2-4x as much, and are not allowed to practice independently. Duning-Kruger is real, and though I know I am much more knowledgeable than a new NP/PA grad, I would absolutely not be comfortable practicing independently.

WHAT CAN YOU DO?

This is YOUR specific political aisle's chance to win over the healthcare professional world. All the science is 100% against what these midlevel organizations are trying to do, and both political parties are in deep with them.

Anyone can help Physicians for Patient Protection: https://www.physiciansforpatientprotection.org/

You can e-mail/call your congressmen and governors when you see bills like this. I will try to post when they occur.

Mostly, you can build that movement here. This is an issue absolutely no one but us health professionals are talking about, and no one is listening. Please, hear us.