Bloomberg Report Questions NP Education

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

Transcript

0:07

Welcome to Patients at Risk, a discussion of the dangers that patients face when physicians are replaced with non physician practitioners. I'm your host and the co author of the book, Patients at Risk, and the author of the follow up book, Impostor Doctors. Rebecca Bernard. Today, I'm sharing a breaking article from Bloomberg Business by investigative journalist Caleb Melby and colleagues, and it's called The Miseducation of America's Nurse Practitioners. Was published just this last week, and I'll share the link in the podcast notes. Now we first learned about Caleb Melby when it comes to nurse practitioners, because he was one of the investigative journalists researching the company Cerebral and others like that. There was another one called Dunn and various others. That really became prominent during the COVID 19 pandemic, especially during stay at home orders. And these companies were offering at home mental health care. And in particular, they were offering controlled substance medications for ADD and led to a really significant rise in the number of stimulant prescriptions. So Melby and his colleagues wrote some articles that basically discussed concerns about this rise in these medications, the potential impact on patients. Perhaps that work led to some of what we're seeing now, which is that the CEO of Dunn was actually arrested along with the company's clinical president for fraud, because they provided easy access to stimulants like Adderall and Ritalin over the internet, For monthly subscription fees. And of course, these companies almost exclusively hired nurse practitioners and not physicians. So Caleb Melby and his colleagues at Bloomberg, apparently this raised some alarms to them. Why are there so many nurse practitioners working for these companies? I did receive an email from Mr. Melby in December of last year. that he had actually gotten a copy of Patients at Risk and was reading it and really interested in the topic and wanted to explore this significant growth in nurse practitioners. So just this last week, published the first in what is going to be a series on nurse practitioners. And the first article was titled the Miseducation of America's Nurse Practitioners. And the title says 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. And this article shares. Stories and Anecdotes of Patients That Were Harmed by Improperly Trained Nurse Practitioners. For example, the first story they share is the story of Fred Bedell. He went into an emergency department in 2020 with severe abdominal pain. And he, of course, as we are seeing increasingly, did not receive care from an emergency physician or even any medical doctor. In fact, he was cared for by a nurse practitioner who had just received his license four months prior The nurse practitioner found that the patient's blood sugar was nearly 600. And of course that should have required admission, but he decided to send the patient home where he died of diabetic ketoacidosis. So the article cites a settlement from the hospital company, which was HCA Healthcare, One of the largest for profit health systems in the country the settlement paid out 750, 000. The article says that the family members can't discuss the case because of that payout, but the investigators on their review, Cannot see any evidence that a physician, was ever involved in the care of the patient. Now, the article points out that this is not unusual, that there are now they say more than 300,000 nurse practitioners, but actually the A A NP. In their most recent article on their website says that there are 385, 000 nurse practitioners now. And of course, the article points out that the growth of nurse practitioners is significantly faster than the growth of physicians. In 2014, there was one nurse practitioner for every five physicians, but just 10 years later, it was 1 to 2. 75. And of course the number is growing by 45%. So the article points out that many patients are receiving care from nurse practitioners because of physician shortages, but also because nurse practitioners are less expensive to hire and that organizations are billing insurances and patients for their care at the same rate as physician care. So, then the article gets into what the training of nurse practitioners are. And the Bloomberg journalists interviewed a large number of nurse practitioners across the country, and even some educators. And they raised very serious concerns about the education. And this is echoing what What we have shared here at the patients at risk podcast, and in fact, some of the same people that have appeared on our podcast were interviewed for this Bloomberg article. The article points out that many nurse practitioners, even in studies as recently as 2021 found that new nurse practitioner graduates feel uncertain. They are doubting themselves and that they feel minimally prepared and caring for patients with complex problems. The article talks about how physicians have been talking about this, like myself and my colleagues from Physicians for Patient Protection, and, pointing out that the quality is declining and it's not right for patients to think that they're seeing a physician because many nurse practitioners with doctorates may call themselves a doctor. And they point out in this article that the response from associations like the nurse practitioner organizations have just said, well, this is just a turf war and that there's nothing for patients to be worried about. But, the article says that they talked to nurse practitioners who said that they wouldn't entrust members of their own families to be cared for by some of the new graduate nurse practitioners that they've observed. They also point out, as we have, that patients don't always know how these nurse practitioners are trained. They don't know. where to look for that information, and they don't know how to make any complaints against these nurse practitioners. For example, in the case of the patient Fred Bedell, who died of the diabetic ketoacidosis, they point out That the complaint against the nurse practitioner was filed two years after the patient died and that the complaint did not disclose the nurse practitioner's education, history, or even share the fact that the patient had died. The reporters actually had to do a lot of legwork and deep investigation to figure out what actually had happened. So they point out that this is not something that would be easy for the public to ascertain at all. The hospital spokesperson said that the nurse practitioner stopped working at the facility a few days later after the patient was treated and the nurse practitioner did answer the journalists in a text message saying that the incident caused a lot of trauma, but that he's moving forward in life just fine. And according to the article, A final order from Florida's Department of Health in June of 2023 assigned the nurse practitioner 16 hours of additional education on critical thinking and patient assessment. And allowed him to keep his license. So even though he made a mistake that led to a patient death, the recourse was 16 hours of education. Now they go on to talk about that nurse practitioner's education because it, it's an important point that he didn't know how to take care of patients because he received his education mostly online. He went to the University of South Alabama, which I believe is the same. school that nurse practitioner Antoinette Thompson went to, which was the nurse practitioner that was involved in the death of Alexis Ochoa that we talk about in the book, Patients at Risk. And that, you know, that's not surprising because that university It says here awarded the fifth largest number of advanced nursing degrees in the country in 2022. It has a 96 percent acceptance rate. It gives out 800 master and doctorate degrees of nursing each year. every year. And if you attend that school, you only have to visit campus one time. And this particular nurse practitioner received a doctorate in nursing practice with a focus in emergency medicine. And so he was one of those few that was supposedly emergency medicine certified working in an ER, even though he did not clearly know how to properly Diagnose or Treat Diabetic Ketoacidosis. for this program, he was only required to go to campus twice over two years for simulated patient encounters. So having this type of training may not be properly preparing nurse practitioners and the article goes on to cite a few other tragic cases. One of a woman named Tiffany Dunbar, who died while she was vacationing in California from an ectopic pregnancy. About two weeks before she died, the patient had been at a woman's wellness center because she was having some abdominal discomfort and spotting, She was seen by a nurse practitioner with a master's degree from an online program, the University of Cincinnati, and I, it seems like from the article that there was concern that the patient had an ectopic pregnancy, but the nurse practitioner did not share that information with the patient apparently because quote, she saw no reason to frighten Ms. Dunbar with the prospect of dying from an ectopic pregnancy. So it seems like she told her to follow up maybe for more lab testing or an ultrasound, but didn't tell her that she might have or had an ectopic pregnancy. The patient died of that ectopic The article goes on to talk about concerns about clinical rotations, pointing out that students only need 500 clinical hours to graduate, which is less than 5 percent of the amount that physicians require before we can practice medicine. And they point out that these preceptorship hours are really hard to get, that students sometimes have to pay out of pocket for them, and that they're really not standardized, no one really knows exactly what the quality of that clinical education is. The article interviewed Linda Steele. who is the former head of nurse practitioner programs at Walden University, and she raised concerns about the placement of students with preceptors that she felt were not the quality that they should be. Walden University is one of those programs that a lot of people call a diploma mill between that one and Chamberlain University, which are both owned by a publicly traded company called AdTalem Global Education. Those two programs gave out more than 8,600 advanced nursing degrees in 2022. And the article points out that this for-profit company has made a lot of money on their nursing programs. In fact, that company earned 1. 5 billion in 2023 Much of which came from its nursing degrees. And they point out that that AdTalum was a company that you might have heard of before because they used to be called DeVry University. The company changed its name after facing class action lawsuits and investigations and they actually paid a hundred million dollars to the Federal Trade Commission in 2016 for deceptive ads. some of their programs were suspended and they were facing a bad reputation so they changed their name and now most people have never heard of Ad Talum. But they do own Chamberlain and Walden. which, are producing many of these nurse practitioner graduates. The article interviewed multiple students who said that the schools are not preparing them to practice. There are allegations that the company is just taking student money, giving out diplomas, but actually not doing what is required to make sure that their graduates can adequately care for patients. Now, one of the interesting parts of this article is that they talk about a preceptor clinic. They use this as an example of clinics across the country that are receiving money through third party matchmaking services to train nurse practitioner students. And they reference this clinic called Mujtaba NP walk in clinic in Clifton, New Jersey. And it's really interesting because this is a clinic of medical doctors that were trained outside of the country, so they don't have a license to practice medicine, but it seems like they decided to become nurse practitioners and got a doctorate, so now they have a DNP degree. And, according to this article, they initially called themselves Doctor on their website, but then after the journalists contacted them to ask about it, they took that title off of their website. So the clinic does all sorts of medical treatments, but also does, aesthetic treatments and other kind of alternative care. This article Made it seem like this clinic treated students like labor and just asked them to start seeing patients, wanted them to see as many patients as possible in a short period of time, and didn't actually provide them with education or training. The article talked to several nurse practitioners who were speaking out about their concerns. They interviewed Corey Hoska, who is an NP in Minnesota, who said that a nurse practitioner made some sudden changes to his mother's medicines that he said could have killed her, and that his mom is just way too complicated to be cared for by a nurse practitioner. He even says that his degree from Purdue global. Which was started by Purdue University and then acquired by a for profit school, Kaplan University, is not as rigorous as he had hoped it would be, and he says that he's worried about nurse practitioners who are now entering the system, saying, quote, I personally know of two people who graduated Chamberlain's online family NP program, Who I worked with as bedside nurses that I wouldn't have trusted to start an IV on me, let alone be my provider. The article also interviewed John Canyon, who you heard on this podcast. We'll link to that. And he was also concerned because His father did not receive proper care, in his opinion, from two NPs, one at an urgent care and then another one in an emergency department. Anne Canyon talks about his efforts to improve NP education. And then, Raine Toman, who is not a nurse practitioner, but is a registered nurse, she shared her story about leaving nurse practitioner school because of the poor quality of education, and she talks about the repercussions that she faced when she voiced her concerns after talking with our group, Physicians for Patient Protection, noting that she was told that she, quote, cavorts with our enemies and exhibits, quote, frightening behavior just for sharing her concerns. so they have these anecdotes, but then the article also shares the working paper from the National Bureau of Economic Research, which looked at emergency room treatment of patients at the Veterans Administration where nurse practitioners are allowed to practice independently. And they examined more than 1 million patient records from 44 different emergency rooms and found that the nurse practitioners used more resources and achieved less favorable patient outcomes than physicians, including Increasing the chances of preventable hospitalizations and doubling the length of emergency room stays the AANP dismissed that working paper as an outlier. They said it was still being peer reviewed. So again, this was the first in a series of what I believe is going to be three articles on nurse practitioner education. And it took about a week, but it seems like the AANP finally did produce a response to the article in a letter to the editor for Bloomberg, current AANP president Stephen Ferrara, DNP, wrote a response. I think it's interesting on just on a caveat, a lot of the people speaking out and representing nurse practitioners are men. And it's funny because it's been a, a woman dominated field for a long time. And in fact, when physicians speak out against nurse practitioner, independent practice, sometimes we're accused of misogyny because it's a more female dominated, whereas physicians as a more male dominated profession. But you can see, of course, that the tide is changing. that women now are 50 percent of medical schools and increasingly men are practicing as nurse practitioners. So the current president is a man and He writes here that the article, the Bloomberg article, the authors have failed to write a balanced story by cherry picking negative information and failing to report the enormous contributions nurse practitioners make to patient care and across the healthcare system. They say in this article that the authors have omitted the fact that NPS have consistently risen to meet our nation's health care challenges. Of course, talking about them stepping in during the pandemic when they utilize that opportunity to get unsupervised practice in a number of states. The AANP criticizes the authors for not including in the article multiple studies that they sent to the authors saying that that it demonstrated their high quality care. I'm guessing they may not have been included because those articles did not involve unsupervised nurse practitioners because there are no articles or studies on unsupervised nurse practitioners. The AANP cites the National Academies of Science, Engineering, and Medicine, which is the previous Institute of Medicine, which of course we know has been a huge ally and supporter of nurse practitioners. The ANP cites several different think tanks including the American Enterprise Institute and the Brookings Institution, sharing the same studies saying that they. provide comparable care to physicians, which of course, you know, when you dig into them, again, these were studies of nurse practitioners that were working with physicians under physician supervision or caring for lower risk patients almost every single time. They claim that there are, there's no evidence of harm to patients but the truth is that really hasn't been evaluated. There have not been any randomized trials. The truth is we really don't know. We haven't actually examined unsupervised care. The AANP says that Nurse practitioner programs are nationally accredited and that they're held responsible to the Department of Education. They say that the clinical rotations must adhere to accreditation standards. So they say all of these things, but But yet the article points out that that is not what is actually happening. So it's really disappointing that the AANP doesn't take seriously the concerns that are being pointed out by NPs and by NP students to say, Hey, you know, maybe instead of being defensive, maybe we should actually look at what's happening and see if we can fix it and improve our education. So ultimately the article concludes generalizations sensationalism and cherry picking should not be used by news sources to disparage NPs or other professions that are caring for patients and their families throughout the nation. And this is the usual mantra that we hear instead of taking seriously concerns about patient safety, there's just defensiveness, accusations, and gaslighting basically of These journalists, I just have to applaud them so much for their bravery in speaking out about this because I'm sure you'll see comments if you go to the different Bloomberg posts on Instagram, Facebook, Twitter, that lots of of NPs and advocates are piling on saying that it's unfair, that it's biased, but also you'll see a lot of comments by NPs who are totally agreeing and with what this article is pointing out. So I'm looking forward to seeing what the next two articles bring. I also want to let you know that Physicians for Patient Protection was definitely involved to a certain extent in this article in that several of our board members spoke with the journalists to give them background information, provided them with resources. And it's really gratifying to know that these really diligent investigators, you know, they're not just going to listen to us and take our word for it. They listen to what we had to say, but then they did their own investigation and they dove into these stories and the data and the literature. And these are their conclusions. It's not, they're not just repeating our talking points. They have mounted their own concerns, and I think they're very valid concerns from anyone that is a patient or will be a patient, which is all of us. We need to make sure that whoever is providing our care is properly trained, properly educated, and it's not just about access, it's about access to quality care. Thanks so much for listening. I'll come back and share with you the future articles. I hope that you'll check them out. If you've enjoyed this podcast and you'd like to learn more about this topic, please consider getting the books Patients at Risk and Imposter Doctors. They're available on Amazon and at barnesandnoble. com. We also have them in an audible version. If you're a physician and you'd like to help support our work to ensure physician-led care for all patients and truth and transparency among healthcare practitioners, then I would love for you to join our group. It's called Physicians for Patient Protection. You can learn more at our website, physicians for patient protection.org. Thanks so much and we'll see you on the next podcast.