Many here have criticized the AMA for "doing nothing". I have defended them. Here is an example of the AMA going on offense to sue the state board for not enforcing rules.
AMA, IMHO, deserves our support.
Fitzpatrick, J. J., Mehlman, M. J., Plemmons, A., Duffy, E. G., Votruba, M., Gerlick, J. A., Davis, S., & Norful, A. A. (2026). The Impact of Nurse Practitioner Full Practice Authority on Chronic Condition-Related Readmissions and Emergency Department Visits in the United States. Medical Care, 64(4), 192–197. https://doi.org/10.1097/MLR.0000000000002285
I have to say that I LOVE science. Like - real science. It is the only way we know anything about our world. I see it being abused in order to push political and business and power goals, and that infuriates me. That is a major motivator for me.
These papers are a bad parody of science. Sadly, they are dressed up so that non-scientists believe them.
Oh BTW - in this table, they never describe what groups (1) and (2) are, and they never indicate what is meant by the asterisks. And - there is no real description of what the numbers are. They say it is a comparison of two states that had independent practice passed, with a measurement before and after the law was passed. This one is disorienting to me (as above). It's hard to believe that the numbers they put in there have no discussion, but what discussion there is is indecipherable. If anybody wants to look at it and show me what they are measureing with these numbers, I would be very interested in this and would appreciate the input. I am very serious about this. We are writing a letter to the editor and I don't want to make a stupid mistake that someone else may find. (My two co-authors haven't been able to find out what is going on here either)
Oh just for amusement - the paper is about readmission rates for these conditions. Have you ever heard of anyone at all being admitted for high cholesterol? And then readmitted for high cholesterol? Like an emergent recurrence of hypercholesterolemia?
same is true of hypertension. Admissions for that do occur, but they are vanishingly rare.
Consipicuously absent in their paper is an examination of readmission for diseases one actually getss readmitted for - like malignancy and like congestive failure. I think they combed through the data, and picked the few postiive ones they could find.
We look closely at the studies that Butler reviewed, and unsurprisingly find that all is not as they represented it.
This has been discussed before here on r/noctor. some threads:
https://www.reddit.com/r/Noctor/comments/1r43ab5/cochrane_says_doctors_can_be_replaced_by_nurses/
https://www.reddit.com/r/Noctor/comments/1rtp65r/cochrane_review_substitution_of_nurses_for/
This is not the end of the discussion, you will be hearing more about this...
Suggest you bookmark these and drop them on Social media whenever appropriate. (Links are to the same video, just for more flexibility
https://www.physiciansforpatientprotection.org/in-the-news/videos/
This just was passed at the AMA meeting. There are a number of things to say about this
In closing, I want to point out that the AANP has as a stated goal, posted on their official website, to promote nurses as the leaders of the care team. Clearly this is advocating for REMOVING physicians as leaders of the care team. They want to remove the most experienced, most expert people - physicians- from caring for patients. We have an absolute obligation to aggressively oppose this. It is dangerous. If we physicians, as we have in the past, do nothing, the AANP will get their wish, and patients will be harmed.
flying back from Paris to Charlotte, and I am following the path all the way. You know how they label cities to orient you, well Columbus is on every one, along with Philly, Houston, boston, toronto,. No Chicago. No Cincy, No cleveland.
There are good and bad things about CBUS being recognized as a major city
For Saturday 5/9/26
Staying at the airport hotel. 10:00 flight. Got to security about 7:00 AM. The first check was a passport check, which was slowed up by the fact that about every other person, the facial recognition failed and they had to go to different kiosks back-and-forth. Then the next layer was to get in line to have your boarding pass check. After that line there was a line for security. I have never seen such slow security checking. All in all, it only took 40 minutes, however we were, of course very early. I would say, it was very hot in the room though.
ETA: forgot to mention we only had two carry ons apiece, so we missed the luggage check line. Which was long.
(the following written by Amy Townsend, MD, a PPP and Tx400 member):
"Finally some accountability for uneducated, lay people that think they can willy nilly perform medical procedures in med spas with impunity.
For those who may not have followed this case—Jenifer Cleveland died in 2023 after receiving an IV treatment at a Texas med spa. This week, criminal charges (including felony murder) were finally filed against the individual involved.
In response to this tragedy, Texas passed Jenifer’s Law, strengthening oversight and patient protections in med spa settings. This was the result of relentless advocacy by TX400 (a grassroots physician advocacy group) and the Cleveland family. We also worked with the Texas Medical Association and legislative leadership from Senator Donna Campbell and Representative Angelia Orr.
Let’s be clear—these are medical procedures, not spa services. And yet we continue to see individuals with minimal training performing them, often without appropriate physician involvement or oversight.
We cannot normalize this. Patients deserve to know who is treating them, what their training is, and who is ultimately responsible for their care.
This case is tragic—but it should serve as a turning point. Accountability matters. And so does protecting the integrity of our profession."
I (PS) would add that I feel horrible about Amber Johnson. Another life and family shattered.
However, this could not go without accountability.
Johnson was someone who had never worked in health care ever, untill she took a 2 day course in how to be an "injector". The company helped her by connecting her with an anesthesiologist who was willing to be her "supervisor". He was there for opening day, and that was the extent of his involvement. He lost his license - but only temporarily. Not adequate. One commenter said that the anesthesiologist may be charged as well.
Speculation is that Jenifer recieved some IV solution that contained enough potassium to kill her, but we have not seen yet what the investigation revealed.
Members of PPP also in Tx400 aggressively pursued the legislation that you see above, and you will not be surprised that the legislation was just as aggresively opposed by some med spa association. It is sad but true that sometimes someone has to die to force change.
https://www.facebook.com/texas99.KNES/posts/1449526413297505/
Dear r/noctor redditors
In February, Cochrane published a review of “substitution of nurses for physiciansx in the hospital setting”
(https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013616.pub2/full)
Several have commented on this previously
https://www.reddit.com/r/Noctor/comments/1r43ab5/cochrane_says_doctors_can_be_replaced_by_nurses/
https://www.reddit.com/r/Noctor/comments/1rtp65r/cochrane_review_substitution_of_nurses_for/
A prior review by them, centered on primary care, was published in 2008 and updated in 2018 concluded that evidence showed that nurses were as good…. Or better... than physicians in primary care.
This prior review was just awful science, and we were pleased to tear it apart in a legislative subcommittee meeting.
My colleague, Dr. Rebekah Bernard, and I have a publication in process addressing this new article.
cut to the chase- it is just as bad or worse than the prior study.
However, this time we are going to get a publication in the literature in a timely fashion, so that whenever someone searches and gets the Cochrane review, they will also get our deconstruction of the paper.
Before this is published formally, you can see the content of the paper on the Physicians for Patient Protection website.
summary:
The authors of the Cochrane study (Butler et al) state as an objective: “The main objective of this review was to examine the impact of substituting nurses for physicians in the hospital setting (hospital inpatient units and outpatient clinics) on patient outcomes, process of care outcomes, and economic outcomes.”
They conclude: “In our review, we found little to no difference between nurse‐physician substitution and physician‐led care. Although nurse‐physician substitution may result in better outcomes in certain cases, the evidence is uncertain. In considering nurse‐physician substitution as a solution to physician shortages, we also need to consider its impact on the nursing workforce.”
Now, you should read the entire link to the PPP website above to get the entire story, but I can do a bit of a summary here.
Their title and verbiage encourages the causual reader to believe that the nurses were caring for patients in the hospital independently. And that all 82 papers were about this.
No.
Only 7 papers even approached the issue of inpatient care. The other 76 were not inpatient care. They occurred on hospital property, it seems, thus weaky justifying being tagged as a hospital study.
Only 6 were in the US. Of those six, the most recent was 2011, 15 years ago. Prior to the rise of the NP diploma mills.
,
The majority of the papers dealt with nurses completing trivial or traditionally nursing activities while still being supervised. For example: Some studies compared two groups – standard physician care and standard physician care + nursing input. This nursing input was for things like telephone follow up or patient education. The finding that patients who had more intensive attention with added nursing-typical activities might do somewhat better is a trivial, unsurprising result and has nothing to do with whether nurses can evaluate and treat patients on their own. YET, these authors included these studies. That fact alone indicates the ethical and scientific bankruptcy of this review. No author should ever include such studies in a paper about nurses replacing physicians. And no editor should ever let something like this be published. Cochrane thus reveals itself to be an advocacy group with no real interest in accurate information.
As a “lowlight” of this type of trivial study, consider the inclusion of the study by Cargill. This was done in 1991. (!). Resident physicians were either told where fecal occult blood testing supplies were located or instructed to refer patients to a nurse clinician; referral increased testing rates. This compares types of instruction—not the clinical performance of nurses versus physicians completing the same task. A true substitution study would require both clinician types performing the same clinical function under comparable conditions.
It is stunning to me that this … very very poor information would ever be included in a real scientific publication. Yet, here we are.
I suppose on one level, it is reassuring that the nursing forces have to make up and distort information to make themselves seem equal. They can’t find any information that actually proves it.
Now – Those of us here are fond of sharing this sort of information. It is, I suppose, a form of talk therapy – ventilation. I engage in this of course, and it is useful, I think as a way to exchange ideas. But it is critical to understand that absolutely nothing happens as a result of our simply sharing here. If you want this to stop, you, and other must take action.
That can be relatively easy. You can join groups fighting this, particularly Physicians for Patient protection (https://www.physiciansforpatientprotection.org) , but also your state Medical society. Go to the meetings, be vocal about this, and demand the state societies actively fight this. Many are, some are not.
If you do not have time to do this, I understand. I was once overwhelmed. However you can have an effect by donating your time in the form of your income for one hour to our group. That helps, and we are using these donations to advance the cause. Help us.
https://www.physiciansforpatientprotection.org/why-support-us/