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    Physicians face punishment for speaking out about non-physician care

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Rebekah Bernard, MD, a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

     

    Editor’s Note: The author spoke with all physicians involved in this blog. All four physicians reviewed the text and approved the details.

    The last thing Steven Maron, MD, expected when he was called into his administrator’s office was to be fired. The Arizona pediatrician said he had never faced any disciplinary actions throughout his 10 ½ years with the organization, and although he had written an opinion piece about nurse practitioners (NPs), he had expressed nothing but admiration, calling them “well-trained, dedicated, popular with patients, and intelligent.”Dr. Bernard

    Which is why the veteran physician of 31 years was stunned when he was abruptly terminated from a Federally Qualified Health Center (FQHC) just days after the article was published in the Green Valley News.

    Maron told me he was specifically told he was being terminated because “my article stood in opposition to the principals of the organization, specifically the principle of mutual respect.” He added that his official termination letter stated, “the company exercises its right to the 90-day out clause…”

    Maron wrote the op-ed in response to a pro-nurse practitioner article published the prior week that began with the following sentence: “Going to see your family doctor for basic needs may soon be a thing of the past.” In “In My View: Are NPs same as MDs?,” Maron presented an opposing point of view: that a physician’s training of medical school, residency, and subspecialty fellowship, as well as inpatient management exposure, adds an additional dimension of care that separates physicians from nurse practitioners.

    While he referred to nurse practitioners as “a great asset” and even asserted that some could “teach some of us physicians a thing or two about bedside manner,” Maron had the audacity to make the following statement: “I am quite concerned about the implications that NPs completely replace physicians. It was never the intent when NP programs were begun to replace physicians, but to function as supervised physician ‘extenders.’” Uh oh. Apparently, those are fighting words. Or more accurately, firing words.

    Unfortunately, the biggest losers in this situation are the patients of Maron’s former employer—patients who utilize FQHCs are some of the neediest and most underserved in the country - who have now lost a dedicated and experienced pediatrician.

    Other physicians have reported job loss for speaking about patient safety issues and non-physician provider care.

    Next: "That’s when I knew I had been blacklisted"

    Rebekah Bernard MD
    Dr Bernard was a National Health Care Scholar and served at a Federally Qualified Health Center in Immokalee, Florida for six years ...

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    • Anonymous
      The problem with limiting the scope of nurse practitioners is that studies and recommendations the Federal Trade Commission, AARP, Bipartisan Policy Center, National Governors' Association and the experience in the twenty-two states that allow NP's full practice authority presents a solid argument that health care is improved for the general population by granting NP's full practice authority. Certainly one can find instances where NP's committed malpractice, just as one can find instances malpractice by MD's. While firing someone who disagrees with the accumulated evidence is extreme, those involved in the administration of health care have strong feelings in favor of delivering competent and cost-effective services to the general public.
    • Anonymous
      The problem with limiting the scope of nurse practitioners is that studies and recommendations the Federal Trade Commission, AARP, Bipartisan Policy Center, National Governors' Association and the experience in the twenty-two states that allow NP's full practice authority presents a solid argument that health care is improved for the general population by granting NP's full practice authority. Certainly one can find instances where NP's committed malpractice, just as one can find instances malpractice by MD's. While firing someone who disagrees with the accumulated evidence is extreme, those involved in the administration of health care have strong feelings in favor of delivering competent and cost-effective services to the general public.
    • UBM User
      I wish I could say something positive in response to this article. I am afraid Dr. Maron probably does NOT have a case because of the wording of his contract. So one lesson, of course, is to READ that contract and get a lawyer to review it as well. As to the Emergency physician commenter, we never have had any job security and never will because of the way our specialty has been taken over by large groups who can easily beat out smaller democratic groups and refuse to hire anyone they wish. Blackballing is rampant in Emergency Medicine. And to all who are forced to "supervise" midlevels in situations where the administration does not give you the power to do so, ESPECIALLY when the midlevels are organized and the docs are not, you had better get out. Whoever said the shit will hit the fan when the public finds out is Pollyanish. The plaintiff attorneys will go after the nominally "supervising" physician, administrators will say "see, here's our policy! " (which they omit to mention they fail to enforce) and the physicians will, as always, be left holding the bag. I'm glad I am nearing the end of my career yet still have the energy and ability to repurpose to concierge medicine. I love it, my patients love me, and there are no "middle-persons" between us to muck everything up. Louise B. Andrew MD JD FIFEM
    • Anonymous
      My favorite aspect of OBG was to focus on infertility problems. While working at Kaiser Permanente in California in 1973, I was told by the department head to stop doing any infertility work--it was not covered by health insurance in the Permanente Health Plan. Either I quit "fitting in my schedule my infertility patients and quit keeping my nurse overtime with these infertility patient's problems or leave. I left. In 1995 while an employee at a hospital in Kalamazoo, using my own ultrasound machine in the OBG clinic was forbidden--even when I never charged for that process, used only to confirm pathology or to be much more precise in my diagnostic decisions. I stopped because the radiology dept complained that it reduced their incomes. Refusing to stop, would result in my being unemployed. None of the OB-GYNs were using ultrasound in their offices at that time. At this hospital physicians were only doing laparoscopic tubal ligations procedures. I had been doing advanced operative laparoscopy for over 6 years when I arrived there. I was forbidden to do them, or even teach other doctors there how to do these procedures safely. When I discovered that their "full compliment of advanced laparoscopic equipment" was sorely lacking I had to stop doing those procedures for safety reasons. Being threatened with termination of employment many times for doing well trained and accredited advanced procedures was the primary reason I chose to quit medical practice earlier that planned. The drift of hospital healthcare functioning under government mandated healthcare proved to me that these smaller town healthcare facilities were at least ten years behind the forefront of cutting edge healthcare--at least in my specialty. Other than being punished for speaking out against mid-level providers (I encouraged my nurse to become a NP, which she later did--her name was Alice), it also includes being punished for being too experienced in medical practice. Attempts to remain on the cutting edge of a medical specialty outside of the superhighway facilities of university standards certainly creates barriers to those physicians who choose to be at the top of their accomplishments. It's a reality I saw for my 40 years practicing medicine.
    • UBM User
      Number one : I don't have to be anonymous when speaking the facts. I have developed and designed computers for doctors and healthcare workers to be wfficient, productive , avoid redundancy. Computers like this and recently even more advanced computer in China which passed the board exam. I can confidently say I can train A PERSON with basic education to function as a practioner treating most common problems which we encounter on a dat to day basis. Is this what we want or we want one to aquire in-depth knowledge of medical science, at molecular and gene level or go through rigorous training to become a surgeon to perform a procedure at best or simply say we can train technicians to perform such procedures from young age like playing golf or tennis. Why bother learning basic medical sciences? I'm appalled by close interaction with mid level people about their knowledge or any basic understanding of simple things . For example when I was in Harvard, one of the young nurses with few years of nursing school would come and get me at while I'm enjotlying my coffee "you your fellow or resident doesn't know what the heck he is doing , you better come and check" well my standard response is " really , lets go check, I would enter the operating room and say " John ! What did you do so far ? four years Harvard under graduate, Foyr years of Harvard medical school , two years of research , five years of general surgery and two years of plastic surgery and second year in fellowship, DAMN MY NURSE KNOWS what you are doing is wrong after TWO years of nursing school, let me recommend the chairman that you should go to Nursing school for few years after your fellowship! Lol haha! , SO is the status of the medical field in this nation these people demanding equal billing , pay scale not realizing WHAT IT TAKES TO BECOME A REAL DOCTOR! pardon typos wrote this on my mobile device Happy to take ? , counsel rests!
    • Anonymous
      The unfortunate thing is that physicians are being squeezed by ever increasing CME and recertification requirements while having their practice shrinking due to PAs and NPs with increasing scope of their practice. The problem is not that you do not know something but that you do not know that you do not know something. One thing for certain is that when the *** hits the fan, hospital and locum tenens administrators will drop you like a hot potato, that is if your contract does not already include a "hold-harmless clause".
    • Anonymous
      It looks as if Dr. Maron can make a great case for infringement of first amendment rights as well as wrongful termination. I hope he gets a good labor and civil rights lawyer. Lost income and punitive damages can help him retire now instead of having to put up with the BS that we doctors now have to by administrators who are looking to replace doctors with cheaper and more pliable mid level practitioners..
    • Anonymous
      Dr. Maron proved again that 'speaking truth to power' is a dangerous undertaking. Many whistleblowers become sacrificial lambs to the system. There are advantages to signing both sides of one's paycheck. Working for someone other than yourself results in little to no job security.
    • Anonymous
      Based on this article, I think most comments will be left anonymously!
    • Anonymous
      Well-written & accurate. Thank you. My place 'closed' it's ICU a while back, and only allowed 'intensivists' to write orders- boarded FP's, IM's, surgeons, etc. were no longer welcome. And NP's are caring for these very sick patients? When a critical mass of people are harmed by the (in)actions of unsupervised mid-levels, the public will figure it out. In the meantime, plaintiff attorneys are licking their chops waiting for their paydays, as more NP's, and PA's make major mistakes. As with government, the populace is getting the healthcare they have chosen by default, (but don't deserve).

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