Tim Lanier  

Let me preface my words by first acknowledging that I work for a phenomenal physician who, as far as I can see, values the work of myself and the other Nurse Practitioners that work in our group.  That being said, this argument that has been raging on between the AMA (Physician's Board) and the AANP (Nurse Practitioner's Board) is absolutely preposterous!  The AMA should be ashamed of themselves and kudos to the AANP for finally getting fed up with story after story and announcement after announcement by the AMA condemning the work of Nurse Practitioners.  I mean, the insulting characterization of Nurse Practitioners by the AMA is utterly ridiculous.  For the sake of proof, I have posted quotes from the AMA website regarding Nurse Practitioners.  Let me warn you... this is a load of you know what!!

"Expanding the scope of practice for advanced practice registered nurses (APRNs) leads to higher costs and reduced safety for patients who are better served by an integrated care team led by a physician whose education and training requirements far exceeds those of other health professionals." -Andis Robeznieks (Sr. writer for AMA)

“Expanding the scope of practice of APRNs to allow independent practice and prescriptive privileges will increase utilization of diagnostic services, antibiotic prescribing and opioid prescribing—all of which can take a real toll on health care costs as well as threaten the health and safety of patients.  We implore you to put patients first and reject this proposal. These added costs and patient safety concerns will place a strain on the health care system, on our patients and on their families.” -AMA President Susan R. Bailey, MD

"It will raise health care costs, not cut them. That’s because NPs in states that allow independent prescribing tend to prescribe 20 times more opioids than NPs in states that do not. NPs also order more diagnostic imaging than physicians. Studies looking at Medicare claims data from 2003 to 2015 found skeletal x-ray ordering increased over 400% among non-physicians, primarily NPs and physician assistants." -taken from story by K. O'Reilly, AMA News Editor

"Removing physicians from the care team is associated with lower quality of care, finding that nurse practitioners demonstrated lower levels of skill than physicians and achieved worse outcomes, despite using more resources,” -AMA Executive Vice President and CEO James L. Madara, MD

The quotes go on and on from the AMA and they aren't just directed toward Nurse Practitioners.  They go hard after Nurse Anesthetists (CRNA), Midwives, and other so-called 'mid-level' professionals.  But its all so two-faced on the part of the loudest mouths at the AMA because they make sure that they keep Nurse Practitioners on staff at all times.  They are lost and cannot function without their Nurse Practitioners.  Trust me, if Nurse Practitioners were really as incompetent as they claim, they would not pay out the salary that they do for our services.  Three points:

1. Nurse Practitioners are a threat to public safety because they demonstrate lower levels of skill than physicians, achieve worse outcomes, use more resources, and are associated with lower quality of care according to Dr. James Madara, CEO of AMA.  
If this is true, then physicians are the bigger threat to public safety because they employ Nurse Practitioners who lack skill, achieve poor outcomes, throw away money, and provide low quality of care.  If this is true, physicians are facilitating horrible medical provision by putting Nurse Practitioners in positions to do harm to patients.  If the chief of police kept hiring bad cops that hurt the public, who would be the biggest threat to public safety?  So then I also believe that, if Dr. Madara's words are true, then he should by lobbying all physicians to refrain from the services of Nurse Practitioners otherwise they (physicians) are the biggest threat to public safety, not Nurse Practitioners.

2.  Nurse practitioners are wasteful, using far more resources, prescribing 20 times more opioids and antibiotics, and ordering tests and imaging studies at a 400% increase compared to physicians.
How was such gross wastefulness able to reach this rate when physicians oversee Nurse Practitioners?  This goes back to the issue of public safety.  If Physicians are supervising Nurse Practitioners properly or, according to the statutes of law, then these exaggerated numbers would not be.  In fact, the AMA should be ashamed to publish this nonsense which is clearly aimed to detour public consumers from Nurse Practitioners and bullying and deceiving them into staying primarily with physicians, because it actually proves that physicians aren't managing or supervising Nurse Practitioners like they should anyway.   Also, I am 1000% certain that patients want someone that, upon suspicion, will order diagnostic testing and the result be clear than to not order the testing to save money.  The health industry is, unfortunately, a business and is run as such.  If this massive level of wasting was true, trust me, the ties would be cut almost immediately!

3.  Patients do not want Nurse Practitioners diagnosing and treating them.
I will say this... there are a lot of 'old school' people that just want a physician- I see it every day in my practice and that's fine.  But to make the broad generalization that patients only want Physicians diagnosing and treating them is reckless and exposes the lack of integrity by the AMA on this subject.  Again I will say, I work for a phenomenal Physician who is highly respected, knows his stuff, and is very successful.  Still, there is a great number of clients that we serve that come just because I am there.  In fact, I am constantly told by patients that they will follow me no matter where I go.  Patients that have been affiliated with the practice long before I arrived, when setting an appointment and given the choice for which provider they prefer, they overwhelmingly say, "it doesn't matter which one I see."  I provide optimal care to my patients and have online reviews to prove it!  I am requested far more often than not and preferred.  Word of mouth about me has been instrumental in our recent influx of new patients who are serviced by both myself and Dr. Chaudhry during admission.  

The AMA is two-faced.  They hire us, need us, put us in positions to make critical diagnosis and treatment decisions, and they lean on us to be extensions of themselves.  Why not ask a hairstylist, musician, school teacher, professional ball player, or even an esteemed lawyer to do this work?  If Nurse Practitioners lack the skill and competence, provide poor quality of care, are associated with worse outcomes, are threats to public safety, are wasteful, and on and on... how could either of the professions that I named fare any worse?  I've learned over time that it is the person that hurls the insults, talks about the other person, and tries to make the other person look bad that is the real person that should not be trusted but instead should be watched carefully and avoided.  The bible says that a double-minded person is unstable in all of their ways.  Again, I will say, not all Physicians align themselves with AMA.  No doubt, every physician will believe that they are the better option in a choice between a physician and a Nurse Practitioner primarily because of the extensive training and education involved in becoming a Physician, but they understand the value of Nurse Practitioners and wouldn't dare degrade our character or ability publicly.  What this comes down to is fear; the AMA fears that consumers, when in a climate where they can choose either a Physician or a Nurse Practitioner, they will overwhelmingly choose the latter.  If and since this is the case, shouldn't the focus be on change- a self-evaluation to determine why a consumer would choose a Nurse Practitioner over a Physician and make the correction?  Get it together AMA- stop being two-faced.  We can't be both useless and needed at the same time!