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Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare
Patients at 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 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 twenty 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 roadmap for patients to protect themselves from medical harm.
254 pages, Paperback
Published November 25, 2020
125 people are currently reading
462 people want to read
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Displaying 1 - 30 of 33 reviews
November 18, 2020
A must-read for anyone interested in how the landscape of medicine has radically changed recently to cut costs and boost profit. This book is well-researched and provides concrete examples of the dangers of mid-level providers being granted full practice authority. Powerful lobbying groups have convinced politicians that 1.5 years of online courses and 500 hours of shadowing is somehow equivalent to the 7-11 years doctors spend refining their clinical skills. The solution is clear, patients should demand to be seen by a doctor when they go to the doctor's office. We should not settle for poorly trained, cost-cutting replacements: the DNPs, FNP-C, and myriad of other non-physicians. Nurse practitioners have a vital role to play in the healthcare landscape, but independent practice is not one of them.
November 21, 2020
As someone who has been personally hurt due to the lack of training and knowledge base of NPs and PAs, I wish I could have read this book before seeking care. We deserve the best-trained physicians when it comes to our health and lives. Thanks to this book, now I know to check the credentials of these so-called “doctors” before each visit!
November 21, 2020
Well researched and gripping, this is an essential read for anyone navigating the modern health care system.
March 2, 2021
Extremely illuminating. I fell down a rabbithole reading about NP/PA practice after receiving some particularly poor care from an NP did not identify themselves as an NP and was listed on my paperwork as my "physician". Very helpful in terms of understanding what folks' actual education and training is likely to be based on their licensure.
(A note that on page 106, the explanation of p-values in the context of a study that is hypothesizing no difference between providers is extremely poorly explained-- if there is an update of this book in the future, I would recommend a re-write for that.)
(A note that on page 106, the explanation of p-values in the context of a study that is hypothesizing no difference between providers is extremely poorly explained-- if there is an update of this book in the future, I would recommend a re-write for that.)
December 4, 2020
Never read. Do no give credence.
This is a blatant attempt by Medical Doctors to complain at their reduced role in controlling how medicine is practiced and reducing how much they can line their own pockets. There is a place for Advanced Care Providers. Making healthcare available to everyone is the goal. Not everyone has the advantage of becoming an MD and the path of a midlevel is a fine path to become a provider.
Less and less people are happy being doctors because they no longer can get rich off us. They don't carry the same lobbying power. The era of all MDs making millions is gone. Most of us don't need an MD for diagnosis and treatment. Most common interventions and primary care can be done by Advanced Care Providers (APPs). Education for APPs is rigorous although I'm in favor of the requirement for patient care hours prior to APP school in order to maintain the experience level of APPs.
As for this book. Don't read it. It is propaganda.
This is a blatant attempt by Medical Doctors to complain at their reduced role in controlling how medicine is practiced and reducing how much they can line their own pockets. There is a place for Advanced Care Providers. Making healthcare available to everyone is the goal. Not everyone has the advantage of becoming an MD and the path of a midlevel is a fine path to become a provider.
Less and less people are happy being doctors because they no longer can get rich off us. They don't carry the same lobbying power. The era of all MDs making millions is gone. Most of us don't need an MD for diagnosis and treatment. Most common interventions and primary care can be done by Advanced Care Providers (APPs). Education for APPs is rigorous although I'm in favor of the requirement for patient care hours prior to APP school in order to maintain the experience level of APPs.
As for this book. Don't read it. It is propaganda.
November 21, 2020
Every patient should have transparency and a thorough understanding of who is treating them. While each member of the healthcare team plays an important role, those roles are distinct and should be commensurate with level of education and training, and do not usurp the role of the most train member of the health team, the physician. This book is enlightening, and actually discounts some of the touted “research“ that has been used to allege competencies to push for independent practice. Education standards in these masters level and “doctorate“ level programs vary widely, and are not on par with actual other doctoral requirements in other fields. Patient safety is imperative, and patient should understand who is treating them.
September 29, 2023
In an age when medical error is the third leading cause of death in Americans, malpractice lawsuits are settled in closed-door secrecy with gag orders on the plaintiffs, and countless others fall prey to defensive medicine and profit-motivated over-treatment, I was hoping that this book's authors could provide a more thorough treatment of the data. Referencing these forms of physician incompetence and systemic failure is no red herring. On the contrary, it's at the crux of the issue: With whom are patients safest - MDs, NPs, or PAs?
So why does this book brush important questions under the rug? Statistically how much medical error and over-treatment, (beyond just outside referrals), can be attributed to physicians as opposed to unsupervised NPs and PAs? Why, despite the rigorous training of U.S. physicians, is so much blood *still* being shed unnecessarily under the banner of medical error? Above all, why is it all enshrouded in so much secrecy?
Readers who, like me, are not health care providers, have likely never heard of the National Database for Malpractice Claims, a federally maintained record of all claims against medical negligence. That's because thanks to well-funded medical lobbying, these reports are deliberately kept secret from the public.
So while Drs. Al-Agba and Bernard center their book around the case of Alexus Ochoa, a young woman who tragically died at the hands of an incompetent and unsupervised Nurse Practitioner, where are the other voices, the stories of those who died at the hands of physicians? While we're leaning on anecdotes, where is the voice of Amber Rose Isaac, a Bronx mother killed by a botched cesarean? Where are the voices of those who could not afford legal counsel apart from a closed-door, secret settlement? Or do some voices matter than others?
These authors needed to go deeper. Instead, they provide only a glib paragraph on the topic on p. 149, paraphrased as, "Oh yea? Well nurses are worse. Here's another anecdote . . . " They proceed to insist that it is easier to win cases against physicians than NPs, an absurd assumption in an era of rampant tort "reform" and other obstacles to seeking justice. (A more thorough study on the issue is available here: https://www.documentcloud.org/documen... )
To be fair, this book deserves more than one star for some of the valid concerns that it raises. It now makes sense to me why one PA that I know, employed at a specialist's practice, is so trigger-happy with costly and stressful outside referrals. Although I plan to stick it out with my unsupervised NP, I have resolved, thanks to this book, to insist on a physician for specialized and hospital care.
In the end, this book raises more questions than it answers, and hopefully these authors will take another opportunity to address these concerns.
So why does this book brush important questions under the rug? Statistically how much medical error and over-treatment, (beyond just outside referrals), can be attributed to physicians as opposed to unsupervised NPs and PAs? Why, despite the rigorous training of U.S. physicians, is so much blood *still* being shed unnecessarily under the banner of medical error? Above all, why is it all enshrouded in so much secrecy?
Readers who, like me, are not health care providers, have likely never heard of the National Database for Malpractice Claims, a federally maintained record of all claims against medical negligence. That's because thanks to well-funded medical lobbying, these reports are deliberately kept secret from the public.
So while Drs. Al-Agba and Bernard center their book around the case of Alexus Ochoa, a young woman who tragically died at the hands of an incompetent and unsupervised Nurse Practitioner, where are the other voices, the stories of those who died at the hands of physicians? While we're leaning on anecdotes, where is the voice of Amber Rose Isaac, a Bronx mother killed by a botched cesarean? Where are the voices of those who could not afford legal counsel apart from a closed-door, secret settlement? Or do some voices matter than others?
These authors needed to go deeper. Instead, they provide only a glib paragraph on the topic on p. 149, paraphrased as, "Oh yea? Well nurses are worse. Here's another anecdote . . . " They proceed to insist that it is easier to win cases against physicians than NPs, an absurd assumption in an era of rampant tort "reform" and other obstacles to seeking justice. (A more thorough study on the issue is available here: https://www.documentcloud.org/documen... )
To be fair, this book deserves more than one star for some of the valid concerns that it raises. It now makes sense to me why one PA that I know, employed at a specialist's practice, is so trigger-happy with costly and stressful outside referrals. Although I plan to stick it out with my unsupervised NP, I have resolved, thanks to this book, to insist on a physician for specialized and hospital care.
In the end, this book raises more questions than it answers, and hopefully these authors will take another opportunity to address these concerns.
November 22, 2020
This book is a must read for 2020. If you care about your health and the health of your loved ones you need to understand about an unprecedented health crisis occurring in the USA right now with the rise of independent practice of NPs and PAs. I have unfortunately seen this with my own eyes.
May 9, 2021
This is a must-read for physicians and patients. Patients are already so confused about who their healthcare provider is (as evidenced by the numerous times I have been called nurse even after identifying myself as doctor), and I know for a fact our patients definitely don’t understand that our DNP is a nurse and not a physician. We are NOT the same! The knowledge, training, and skills are nowhere near comparable, and our patients can suffer because of that. I had an experience with an ortho NP who wanted to discharge a patient from the ED although he clearly had exposed orthopedic hardware in his knee - the plastic surgery team (me) said HELL NO, we admitted him and operated on him next day. Midlevels overtaking medicine is a public health crisis and it’s our responsibility to educate ourselves and take action for the protection of our patients.
July 15, 2021
This book sickens me to my core. Imagine the absolute superiority complex of a person who WRITES A BOOK about other providers being less capable. Save your time and your money.
October 20, 2025
Very important topic with comprehensive discussion on the history and current landscape of midlevels. This book was infuriating to read as a physician. It’s really sad and painful to read about the decades-long systemic lobbying by large organizations that has pushed anti-physician policies all in the name of profits and at the expense of patient care. It was hard to read more than a few paragraphs at a time due to how angry it made me.
I only gave this 3 stars because it was often repetitive, had typos, and was an overall dense nonfiction read. Still a great read for anyone in healthcare or anyone who is a patient and needs a guide for understanding who is going to be taking care of them. Also a good wake-up call for physicians to advocate for themselves to prevent the erosion of US healthcare.
I only gave this 3 stars because it was often repetitive, had typos, and was an overall dense nonfiction read. Still a great read for anyone in healthcare or anyone who is a patient and needs a guide for understanding who is going to be taking care of them. Also a good wake-up call for physicians to advocate for themselves to prevent the erosion of US healthcare.
December 30, 2020
Amazing book! I would highly highly recommend to everyone especially those not in healthcare professions. Here are some takeaways from this book:
- nurse practitioners and physicians assistants are important part of healthcare and they improve healthcare outcome while working side by side with physicians. However, they are not equipped with medical knowledge and clinical training to work independently and there is NO research study showing non-physician providers function as well as physicians while working independently.
- as patients, you have a right to know the credentials of your providers (MD/DO are physicians, or NP nurse practitioner and PA physician assistant). You need to know that the training requirements are different for providers with different credentials (i.e. 4 year medical school and over 15,000 hours of clinical hour for an attending physician VS 1 year online (potentially fully online) nurse practitioner school + 1000 clinical hours). In addition, if you have concerns about your symptoms, you have a right to ask to be evaluated by a physician provider.
- our society, by continuously expand the practice scope of non-physician providers (in terms of practice independently without physician supervision or consult), is creating a slippery slope" for the entire health care industry. Imagine if NPs can practice like physicians, then one day, maybe nurse techs can function as NPs and lay person can function as nurse techs.
- some people advocates for more NPs to address the shortage of Primary care physicians and this rationale is flawed. it shows that we value some people's life less than others. I think the key is to incentivize more medical students to choose primary care and creates more training spots rather than relying on non-physician providers.
Again, I do not think this book is a propaganda. It NEVER says PAs and NPs are endangering patients. Rather, it draws attention to an important question: how to best protect patients' life.
- nurse practitioners and physicians assistants are important part of healthcare and they improve healthcare outcome while working side by side with physicians. However, they are not equipped with medical knowledge and clinical training to work independently and there is NO research study showing non-physician providers function as well as physicians while working independently.
- as patients, you have a right to know the credentials of your providers (MD/DO are physicians, or NP nurse practitioner and PA physician assistant). You need to know that the training requirements are different for providers with different credentials (i.e. 4 year medical school and over 15,000 hours of clinical hour for an attending physician VS 1 year online (potentially fully online) nurse practitioner school + 1000 clinical hours). In addition, if you have concerns about your symptoms, you have a right to ask to be evaluated by a physician provider.
- our society, by continuously expand the practice scope of non-physician providers (in terms of practice independently without physician supervision or consult), is creating a slippery slope" for the entire health care industry. Imagine if NPs can practice like physicians, then one day, maybe nurse techs can function as NPs and lay person can function as nurse techs.
- some people advocates for more NPs to address the shortage of Primary care physicians and this rationale is flawed. it shows that we value some people's life less than others. I think the key is to incentivize more medical students to choose primary care and creates more training spots rather than relying on non-physician providers.
Again, I do not think this book is a propaganda. It NEVER says PAs and NPs are endangering patients. Rather, it draws attention to an important question: how to best protect patients' life.
November 22, 2020
Eye opening!
I would definitely recommend this book to all the physicians, non-physicians and the public, so that we all make informed decisions.
I would definitely recommend this book to all the physicians, non-physicians and the public, so that we all make informed decisions.
July 19, 2024
This is my second time writing a review for this book after it didn't save the first time. :( . Anywho, as I was reading this book I had anticipated leaving a lower rating for it but after completing it I landed on 4 stars. I think this book addresses the incredibly important topic of mid-level scope creep and does a good job of portraying one side of this issue. And since I'm not sure "mid-level scope creep" is a super prevalent phrase or is even correct, this book addresses the rise of nurse practitioners (NP) and physician assistants (PA) in healthcare systems, mainly in America but also across the globe. The book argues that the expansion of these positions has caused many of their organizing bodies to call for the expansion of practicing authority for these positions, which has many adverse health outcomes for patients.
I think this topic is incredibly important as these "mid-level" healthcare positions are definitely becoming more popular and I've heard a lot more about them since entering college. An NP I know personally said that these professions will help fix the healthcare shortage in the U.S., and I think this view is a pretty prevalent one and makes sense to me. Providing more supporting positions to providers will allow them to take on more patients and allow them to focus on cases that are the most demanding of their attention first. This book does not take issue with NPs and PAs as professions, but rather calls attention to the fact that expansion in their practice rights is a slippery slope, and that doctors shouldn't be replaced by these newer positions.
I would say that I fundamentally agree with this argument, but at times I felt the book clouded this point and sort of diminished these mid-level health care professions too much. I think patient distrust is a big issue that NPs and PAs face and this book certainly fuels that problem. Generally, the book has a clear bias, which makes sense as it was written by two MDs. I think hearing from Doctors about this issue is incredibly important and their opinion is perhaps the most value when determining what level of knowledge and skill acquisition is sufficient to provide adequate patient care independently. That being said, I wish there was a book on this topic from a more neutral source, like perhaps an investigative journalist or other writer who could more fairly assess how prevalent this issue is and what its long-term implications are.
This book also used some light fear mongering at times (such as the title lol) and I wasn't a fan of some of the ways the authors' supported their arguments. There was an overuse of anecdotes and questionable sources (Reddit? Quora? like really?) and while I believe an anecdote can be powerful, it just felt overdone at times, especially when there are a large number of doctors who have issued out committed an act of malpractice as well. This book talked about NPs a lot more than PAs but did a good job of describing both positions and their education requirements for the most part. The authors mentioned the prevalence of fully online NP programs a lot and I'm skeptical of how many there really are. I also liked how the authors gave a brief statistics lesson to help explain why/how they aim to discredit some of the studies supporting superior patient care outcomes by NPs.
Very long review but I would recommend this to all my homies interested in healthcare or working as a healthcare professional. Valuable insight and sparked interesting discussion/reflection.
I think this topic is incredibly important as these "mid-level" healthcare positions are definitely becoming more popular and I've heard a lot more about them since entering college. An NP I know personally said that these professions will help fix the healthcare shortage in the U.S., and I think this view is a pretty prevalent one and makes sense to me. Providing more supporting positions to providers will allow them to take on more patients and allow them to focus on cases that are the most demanding of their attention first. This book does not take issue with NPs and PAs as professions, but rather calls attention to the fact that expansion in their practice rights is a slippery slope, and that doctors shouldn't be replaced by these newer positions.
I would say that I fundamentally agree with this argument, but at times I felt the book clouded this point and sort of diminished these mid-level health care professions too much. I think patient distrust is a big issue that NPs and PAs face and this book certainly fuels that problem. Generally, the book has a clear bias, which makes sense as it was written by two MDs. I think hearing from Doctors about this issue is incredibly important and their opinion is perhaps the most value when determining what level of knowledge and skill acquisition is sufficient to provide adequate patient care independently. That being said, I wish there was a book on this topic from a more neutral source, like perhaps an investigative journalist or other writer who could more fairly assess how prevalent this issue is and what its long-term implications are.
This book also used some light fear mongering at times (such as the title lol) and I wasn't a fan of some of the ways the authors' supported their arguments. There was an overuse of anecdotes and questionable sources (Reddit? Quora? like really?) and while I believe an anecdote can be powerful, it just felt overdone at times, especially when there are a large number of doctors who have issued out committed an act of malpractice as well. This book talked about NPs a lot more than PAs but did a good job of describing both positions and their education requirements for the most part. The authors mentioned the prevalence of fully online NP programs a lot and I'm skeptical of how many there really are. I also liked how the authors gave a brief statistics lesson to help explain why/how they aim to discredit some of the studies supporting superior patient care outcomes by NPs.
Very long review but I would recommend this to all my homies interested in healthcare or working as a healthcare professional. Valuable insight and sparked interesting discussion/reflection.
February 7, 2022
Very well-written, well-researched book on the crisis in healthcare today. Everyone has the right to know who's taking care of them. We all know how hard and long physicians study and train for. But many of us do not know that the person in a white coat who comes in to see you may not be a physician and often has just a fraction of the education and training of a physician, and sometimes a lot less training than what would be required of an aesthetician or a pet groomer!
April 15, 2021
Interesting information from the beginning of our medical education to our current state of health care. Patients should definately understand the dynamics that are taking place in our health care environment.
November 2, 2024
wow okay I saw a PMHNP for psychiatry for a while recently and had never felt more sketched out by a provider, and then switched to seeing a MD, realized I didn’t actually know what an NP was, and fell down a rabbit hole
April 15, 2021
This is a book I would encourage everyone to read. There are a lot of problems with the US medical system. This book frames one of the big problems, but you need to read through the book to see the real problem. While nurse practitioners and physician assistants assuming their brief training should allow independent practice is a significant problem, the bigger issue is the business and political interests that will exploit the less trained, cheaper labor. They benefit from believing that advanced practice nurses are equal to physicians. Business leaders will make monetary gains. Politicians will be able to tout policy victories and gain support from well funded special interest groups. But the available data does not scale to determining they can practice independent of physicians.
The book is not excellent. The authors did a good job with what they have, but we need more comprehensive research. We need studies that assess rates of harm to patients. We need studies looking at newly trained practitioners, not very experienced faculty members. We need studies that are long enough to see significant outcomes with chronic health problems, not substitute soft end points. Unfortunately there is not much motivation by the nurse practitioners to study this correctly. They have a conflict of interest to study areas they know they are currently inadequate. Physician led research on the topics will be attacked as biased and the politicians and business leaders seem willing to sacrifice their physicians for the cheaper labor. When we have information like this, a book like this will be convincing beyond comparing length of training of different programs.
The book is not excellent. The authors did a good job with what they have, but we need more comprehensive research. We need studies that assess rates of harm to patients. We need studies looking at newly trained practitioners, not very experienced faculty members. We need studies that are long enough to see significant outcomes with chronic health problems, not substitute soft end points. Unfortunately there is not much motivation by the nurse practitioners to study this correctly. They have a conflict of interest to study areas they know they are currently inadequate. Physician led research on the topics will be attacked as biased and the politicians and business leaders seem willing to sacrifice their physicians for the cheaper labor. When we have information like this, a book like this will be convincing beyond comparing length of training of different programs.
March 29, 2023
A must read for patients. Very well-researched and cited. Would you want a pilot with only 500 hours of flying experience or a pilot with 15,000 hours of flying experience? Answer is obvious. So why are we accepting this from our healthcare? Money is a big driver as NPs/PAs are “less expensive” to hire, but in reality, order more labs, imaging, unnecessarily refer to more specialists and overprescribe medications to make up for their lack of their education. In the end, this costs the system and patient more money, time and anxiety. The nursing profession does an excellent job at marketing to advocate that non-physician midlevels are “just as good” as physicians, when the research has never shown this. Knowledge is power, and when it comes to your health, I would do yourself a favor and read this book.
July 22, 2021
I think that everyone needs to read this because we all need medical care at some point in our lives. We trust that the person providing our care is appropriately trained because why else would they be there? But this book shows that it's more complicated than that and that there is a disturbing trend of underqualified people practicing medicine without being held to the same standard as people with actual medical degrees. All politicians need to read this too.
January 22, 2022
It is well researched and with a lot of good information. It is very clearly one-sided, but the beginning of a journey to understanding the differences in training, understanding, and career goals/trajectory between non-physician providers and physicians. I think if you want to begin to understand this topic, it will take education of both sides, and this is a good first step in understanding one side of the argument.
April 20, 2021
A Must-read for consumers of healthcare in the US. Very illuminating. You will learn from this.
May 24, 2021
Well written, well researched book exploring a burgeoning crisis in healthcare. This is a book I wish every patient could read.
March 2, 2024
This was a disturbing book. It takes ~500 hours to become a nurse, and about ~15,000 hours to become a physician, which is 30 times the amount of studying and experience. As a medical student near graduation, I can probably give you up to 40+ different causes or associations for redness of the palms (palmar erythema), which is probably my widest differential. I can also give you ~35 different causes of intrarenal AKI, and 30+ causes of chest pain off the top of my head. Knowledge of pathophysiology and being able to construct a wide differential is what separates physicians (an M.D. or a D.O.) from nurse practitioners (N.P.) and physician assistants (P.A.).
Unfortunately, patients can't intuitively understand this universe of difference, because expertise is not easy to differentiate, unless you're an expert yourself. In sports, it's easy to tell who is performing at a higher level because expertise is expressed visually onto the outside world which is able to be evaluated against a template of simple rules, but in knowledge fields, you do not have mind-reading abilities with the power to assess high-level cognitive processes and compare them with the acumen of another, which is why up to 40% of patients confuse a nurse with a doctor and believe they are equal in training and knowledge.
NPs and PAs are extremely useful when supervised by an attending physician, but the push in many states for them to have independent practice, and the shady advertising with highly implying that they are just as equal to physicians, combined with the nauseating greed from corporations to save money at the expense of patient safety is not only patently absurd, but a moral failure of the U.S. healthcare system. There is also a massive ego crisis among PA's in wanting to change the title of their degree away from "assistants" and the desperation for some nurses to want to be called doctors or in the case of CRNA's to be called anesthesiologists that leaves a bad taste in my mouth, and reminds me of the deceitful practice of chiropractors gladly equivocating on the word "doctor", many of which do not put in an ounce of effort to specify that they are chiropractors, all in hopes that they will convince people in this obscurity that they are healthcare professionals who went to medical school. The authors and youtubers are especially awful with this, titling themselves as "Dr. Adams" instead of "Dan Adams, D.C." without clarification.
This much is clear, patients need to be given the choice about what kind of provider will attend their medical needs, and place an informed decision about their providers' degree and level of training, just like informed consent would be given for any other prescription or medical procedure.
Unfortunately, patients can't intuitively understand this universe of difference, because expertise is not easy to differentiate, unless you're an expert yourself. In sports, it's easy to tell who is performing at a higher level because expertise is expressed visually onto the outside world which is able to be evaluated against a template of simple rules, but in knowledge fields, you do not have mind-reading abilities with the power to assess high-level cognitive processes and compare them with the acumen of another, which is why up to 40% of patients confuse a nurse with a doctor and believe they are equal in training and knowledge.
NPs and PAs are extremely useful when supervised by an attending physician, but the push in many states for them to have independent practice, and the shady advertising with highly implying that they are just as equal to physicians, combined with the nauseating greed from corporations to save money at the expense of patient safety is not only patently absurd, but a moral failure of the U.S. healthcare system. There is also a massive ego crisis among PA's in wanting to change the title of their degree away from "assistants" and the desperation for some nurses to want to be called doctors or in the case of CRNA's to be called anesthesiologists that leaves a bad taste in my mouth, and reminds me of the deceitful practice of chiropractors gladly equivocating on the word "doctor", many of which do not put in an ounce of effort to specify that they are chiropractors, all in hopes that they will convince people in this obscurity that they are healthcare professionals who went to medical school. The authors and youtubers are especially awful with this, titling themselves as "Dr. Adams" instead of "Dan Adams, D.C." without clarification.
This much is clear, patients need to be given the choice about what kind of provider will attend their medical needs, and place an informed decision about their providers' degree and level of training, just like informed consent would be given for any other prescription or medical procedure.
Read
December 13, 2023I came across this book by accident, while perusing a listing for another one that was recommended for review. I didn’t even know it was out there and thought perhaps I might not be alone.
As the title suggests, the authors have a point they wish to make. This is not just an objective, data-backed analysis but also an argument in support of a premise. Think of it as a documentary film – it has its particular point of view and what gets presented tends to lead one toward accepting and agreeing to that POV.
Read our entire review and see more book club selections on The DO!
As the title suggests, the authors have a point they wish to make. This is not just an objective, data-backed analysis but also an argument in support of a premise. Think of it as a documentary film – it has its particular point of view and what gets presented tends to lead one toward accepting and agreeing to that POV.
Read our entire review and see more book club selections on The DO!
This entire review has been hidden because of spoilers.
January 4, 2021
As educated consumers of healthcare, this is a must read for all patients. The commoditization of healthcare has not contained costs. The monies are being redistributed and the agenda is not always for better care or outcomes. Very interesting read.
January 6, 2021
Excellent book with analysis of how increasing use of NPs, PAs and corporatized medicine are affecting healthcare in the US. Very data driven.
October 16, 2021
Very important to be educated on who is providing your medical care and what experience/education/supervision they have!
October 23, 2022
A friend (with whom I have a policy disagreement) recommended I read this book. It's not terribly persuasive and relies heavily on anecdotes. Was hoping for something more data-driven or interesting.
April 7, 2022
This book is well written and the material was obviously researched well. As a practicing NP, I am biased reading this, as is nearly anyone in the medical field that reads this book. Regardless, I found myself agreeing with most of what the authors wrote. Things that I agree with them the most about are the faulty and inadequate education for NPs and the lack of supervision that NPs receive in their jobs. I have never been a proponent of full practice authority (FPA) for NPs. I think if anyone looks at FPA objectively, they would have to conclude that it is absolutely ludicrous. I completely agree that NP education should be much more rigorous and intense. It should certainly include more clinical hours. One of my biggest complaints from my experience in NP school was that we were responsible for finding our own preceptors for clinicals. This was half of the stress related to NP school (take that as you will). During my experience in NP school, I had colleagues that felt cocksure about coming out of school and treating patients. This type of attitude will only end in bad patient outcomes. I agree with the authors that compared to MD school, NP school is a joke! I have been of the belief that as an NP, I should know my limits and consult with my physician as often as needed to make sure that I am treating patients appropriately.
Some critique of the book would be that I think the authors should have placed more blame of the current mid-level problem on physicians themselves. Many physicians are lazy are profit-driven and could not care less to "supervise" their NPs. I also think that the "social justice" bit at the end of Chapter 5 was awkward and out of place. Furthermore, I disagree with the premise.
Overall, good read and would love a complete reform in NP education and NP practice.
Some critique of the book would be that I think the authors should have placed more blame of the current mid-level problem on physicians themselves. Many physicians are lazy are profit-driven and could not care less to "supervise" their NPs. I also think that the "social justice" bit at the end of Chapter 5 was awkward and out of place. Furthermore, I disagree with the premise.
Overall, good read and would love a complete reform in NP education and NP practice.
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