Patients at Risk

The Rise of the Nurse Practitioner and Physician Assistant in Healthcare

By: Dr. Niran Al-Agba, Dr. Rebekah Bernard

Narrated by: Manny James

Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare exposes a vast conspiracy of political maneuvering and corporate greed that has led to the replacement of qualified medical professionals by lesser trained practitioners. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for the guardians of our nation’s healthcare continue to decline - with deadly consequences. This is a story that has not yet been told and one that has dangerous repercussions for all Americans.

With the rate of nurse practitioner and physician assistant graduates exceeding that of physician graduates, if you are not already being treated by a non-physician, chances are, you soon will be. While advocates for these professions insist that research shows that they can provide the same care as physicians, patients do not know the whole truth: that there are no credible scientific studies to support the safety and efficacy of non-physicians practicing without physician supervision.

Written by two physicians who have witnessed the decline of medical expertise over the last 20 years, this data-driven book interweaves heart-rending true patient stories with hard data, showing how patients have been sacrificed for profit by the substitution of non-physician practitioners. Adding a dimension neglected by modern healthcare critiques such as An American Sickness, this book provides a road map for patients to protect themselves from medical harm.

©2020 Universal Publishers (P)2021 A Doctor Writes

Eye-opening

I wouldn’t trust the flight attendants to fly in place of the pilot; why are we tolerating this in healthcare?

Thank you for the enlightenment!

Very well written and educational. Would recommend to any future doctors as well as patients. Thank you so much for elegantly writing this book.

Shocking and Eyeopening

**To anyone who has been treated by a nurse practitioner, physician assistant, CRNA, nurse midwife, or other non-physician providers or is unsure if they have or have not, this book is for you.**

Healthcare is being taken over by greed. Medicine is the opposite of greed. In the name of “access to care” and “cost savings”, patients are being put at greater risk by convincing the public that mid-level providers are somehow equivalent to physicians while practicing independent of them. The problems that healthcare faces are not being solved by more mid levels and their expansion of scope. And in many cases, the problems are worsening. Mid-level providers are crucial members of our healthcare team like all others. It is when we disassemble this team and appoint more than one quarterback, that the patients suffer.

One of the scariest nonfiction books published

This is a must-read book if you are an American utilizing US healthcare services. Patients need to be educated about who is treating them and demand physician-led care.

Brutally Honest!

I am a physician specializing in Psychiatry. I just completed my 4 year residency in Psychiatry in the US and a 6 year medical school in India , took 3 part USMLE exam ( US medical licensing exams) before I was licensed to practice independently in the US. On top of that I just got board certified by the American Board of Psychiatry and Neurology as a testimony to my expertise in my field. Overall I have finished 10 years of medical education, 5 licensing exams, each of which were 8-9 hour long, USMLE step 3 being a 2 day exam and have cost me over $10000 to be designated as a board certified physician in the US. These exams included hundreds in of questions in Medicine, surgery, pediatrics, OBGYN, ethics, Biostats before I was allowed to be licensed.

When I started practicing in the real world with NPs just a few months ago, I was aghasted by the misdiagnosis and poly pharmacy that’s happening on our mentally ill patients. This is the most vulnerable population with limited insight and can be adjudicated to have forced treatment. In my opinion, NPs and PAs should undergo 1-2 year of standardized in person training in the field they choose to practice in and never be allowed to practice without a physician overview. The book helped me appreciate the widespread mismanagement and encroachment in different fields of medicine and the importance of organized medicine and patient advocacy by physicians. If I am a patient, I expect to be treated by a physician like me or at least see a physician during my encounter as was the case throughout my residency training where all patients saw an attending physician during the visit after seeing me. It’s time when corporates stop making money out of us and treat medical field as a business.

A Must-Read Book

A superb review of the major changes in American healthcare that are occurring right under our noses. I think most people, both in and out of the healthcare system, are unaware of just how prevalent inadequately trained Non-physician Providers are, and the extent to which Corporate Equity firms and large hospital conglomerates are using them to replace highly-trained physicians. This scope creep puts all of us at risk. This book is a strong warning that we need a major course correction.

Terrifyingly true!

I am an emergency physician with 37 years of experience. This book is spot-on correct. Properly supervised in real time, PA’s and NP’s can and do serve as safe, effective care extenders. When working without active, appropriate supervision, PA’s and NP’s often get into situations where they either don’t understand the patient’s problem and how to treat it, or they don’t even know there’s a problem to begin with. The book’s main shortcoming is that it fails to address the economic forces at work strongly enough. PA’s and NP’s salaries are often less than half of what a fully trained, experienced physician gets paid, but organizations utilizing the mid levels can still bill for 85%-100% of what they bill for physician services. Simply put, it’s the same revenue for half the cost. And since administrators are virtually never personally liable for harms their systems cause patients, liability insurance premiums and loss payouts are viewed as simply a cost of doing business, which reduces avoidable patient suffering and death to nothing more than entries on a balance sheet. This is an important book that should influence every healthcare policy maker in this country, but unfortunately, I am certain it will be vilified as arrogant, inaccurate, sensationalized, and misleading by every professional organization whose members seek to get their hands further into the cookie jar. I admire Dr. Al-Agba and Dr. Bernard for being brave enough to publish it.

Well written book

I think this was a very well written book detailing the history of the NP and PA professions, and literature behind the optimal utilization of these professions. I am in healthcare, but I think it was written in such as way that someone who is not in healthcare at all could understand how things came to be, and understand the cited studies. Ultimately it’s points include the fact that training for NP/PAs is vastly different than that of physicians and that the studies conducted show that their skills can be effectively utilized when under the supervision of physicians. No studies to date have been done comparing physicians to NPs or PAs without any physician supervision. The book also discusses things that should be considered to help alleviate the shortage of healthcare workers. It also gives non-healthcare workers things to ask when getting care to understand who is actually treating them and what their roles are.

Eye-opening!

Very well-written and thoroughly researched. Thanks for bringing such issues in our healthcare system to light.

What you should know as a patient in the USA

As someone who has worked in clinical support roles within healthcare for the past 9 years, even I was not aware of the vast differences in training of healthcare providers like NPs, PAs and medical doctors. I am starting medical school soon and am now aware of how naive even those working in healthcare, healthcare administration and in policy making can be about the limitations in the training of many people who take care of us. This is even more obscure to the general public who has little knowledge of the inner working behind the medical curtain. Just as we research expensive purchases to make sure we are getting the best value, we are ALL patients who need to research the credentials, differences in training, and any dark marks on the professional record of anyone who is caring for our health. Why we are so diligent in researching the best bank to take a loan with or the best car to buy for safety and value, but will flippantly trust anyone with a stethoscope or a white coat is incredibly illogical. It is beyond me. This is the beginning of the end of quality medicine in the US. We are headed for a monumental crisis in US healthcare outcomes. We thought it was bad before, it's about to get a lot worse if it continues in the way it is going now with legalization of increased scope of practice for those without the most extensive and adequate training.

If you think this is simply a book bashing NPs or PAs, then do your own research.
It is only saying physicians should lead all healthcare teams and that those with less and different training should be part of the physician led tea. No team can have all captains...but this is what is happening in medicine. All healthcare providers are NOT equal.

Look up the studies that the nursing lobbies speak about and analyze it for yourself. Look up schools that offer NP degrees, PA degrees and MD/DO degrees. Look at their admission requirements and curriculum. Look up your state's requirements for independent practice of non- physicians.
Look up the requirements for independent physician practice. You WILL find that while the LEGAL allowances for ptactice are similar, the training, requirements, and regulations of each profession are very, very different. This should make you think twice (or more) about trusting your health to just anyone who wears a white coat and stethoscope. Be educated. Training matters. Physician led medicine is best. This book definitely discusses the realities of this.

Note: only gave 4 stars because several statements in the book are a bit repetitive, which was annoying, but maybe are repeated for emphasis. The narrator's voice is also really monotonous and dry, but that doesn't change the content of the book.