Let's lobby with insurance to increase malpractice restrictions for "providers"

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psychic_hearts

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My title is the TLDR. I live in a state where the NP independent practice passed and now it looks like PA independent practice passed in house. Join physicians for patient protection. Write to your medical organization (hopefully they can prove themselves less useless) What I am hoping PPP can do is lobby alongside insurance industry to increase malpractice coverage to two to three times for these ancillary practitioners unless (loop hole) they have physician supervision as was the previous standard. It can be made a law named after one of the many people who have died under NP independent practice. Unless we do this to increase restrictions/protect against hospitals using the bottom line to have increasing amounts of ancillary professionals who work unsupervised more will die from basic things like an unrecognized pulmonary embolism that killed a young girl when an ARNP was left in charge of an ER. Don't bemoan your state already passing these bogus legislations that toxic nursing lobbying has insidiously tricked legislators to passing. Every year let's lobby with insurance to increase their rates. I envision insurance will be more than happy to aid our lobbying especially as more malpractice cases rack up due to this clown world.
 
psychic_hearts said:
My title is the TLDR. I live in a state where the NP independent practice passed and now it looks like PA independent practice passed in house. Join physicians for patient protection. Write to your medical organization (hopefully they can prove themselves less useless) What I am hoping PPP can do is lobby alongside insurance industry to increase malpractice coverage to two to three times for these ancillary practitioners unless (loop hole) they have physician supervision as was the previous standard. It can be made a law named after one of the many people who have died under NP independent practice. Unless we do this to increase restrictions/protect against hospitals using the bottom line to have increasing amounts of ancillary professionals who work unsupervised more will die from basic things like an unrecognized pulmonary embolism that killed a young girl when an ARNP was left in charge of an ER. Don't bemoan your state already passing these bogus legislations that toxic nursing lobbying has insidiously tricked legislators to passing. Every year let's lobby with insurance to increase their rates. I envision insurance will be more than happy to aid our lobbying especially as more malpractice cases rack up due to this clown world.
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I see this claim thrown around sometimes. Is there any actual objective data to this effect?
 
psychic_hearts said:
Data should be compiled in meta analysis as more cases occur. I referenced that one specific case as the law firm that represented that girls family made a public statement on this matter to the effect that this is malpractice paradise
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But where is the data that supports a claim that there are more malpractice claims made on NP/PAs than MD/DOs, per capita?
 
WisNeuro said:
But where is the data that supports a claim that there are more malpractice claims made on NP/PAs than MD/DOs, per capita
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The data exists but not in a structured form. Let's start compiling the data in google spreadsheet. These are good questions and we need to start gathering it thus why I am making this post.
 
But, the way you present the issue is that you have a solution in search of a problem, rather than having data that would suggest a specific problem. Also, I imagine insurance companies would be wary of such a joint venture as they would potentially be opening themselves up to restriction of trade lawsuits with clear signs of collusion. I think it's legally much more difficult than you think it is.
 
WisNeuro said:
But where is the data that supports a claim that there are more malpractice claims made on NP/PAs than MD/DOs, per capita?
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A little old, but relevant:

SAGE Journals: Your gateway to world-class research journals

Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.
journals.sagepub.com journals.sagepub.com

Compares malpractice reports and adverse actions between physicians, NPs, and PAs from 2005 to 2014. Figure 1 shows number of malpractice reports against physicians decreased by 11.5% (2,100 reports less) while PAs increased by 128% (366 reports) and NPs increased by 123% (255 reports). Nothing conclusive that should dictate policy, but some interesting info.

Another report from 2017 specifically comparing malpractice cases and outcomes for NPs from 2012 to 2017 showing significantly worse outcomes with some interesting shifts possibly suggestive that less supervision may play a role (my take, not stated in report):

 
Interesting, but not a slam dunk as to the OPs issue, with physicians having a much higher per capita rate, despite the decrease. I'd also be curious if there is a case-matched design somewhere given the differences in laws between states in terms of autonomy.
 
Some of the troubles are larger health systems will quietly ignore the issues that present from midlevels or simply fire them or not renew their contracts and they move on to the next place. And the cycle repeats until settling to the 'bottom' of practice venues. For instance the medical director or other physicians catch the issues and mitigate the damage before it rises to level of malpractice case but they quietly get pushed out. Then eventually the midlevel ends up practicing at the CMHC...

Another issue is typically having lower expectations, or clinical roles that buffer some midlevels from rising to the point of having malpractice cases by not treating more complex patients.

The confounding issues that impact a true head to head comparison are numerous.
 
WisNeuro said:
Interesting, but not a slam dunk as to the OPs issue, with physicians having a much higher per capita rate, despite the decrease. I'd also be curious if there is a case-matched design somewhere given the differences in laws between states in terms of autonomy.
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Of course it's not a slam dunk, but it is a good starting place. I agree that I'd like to see a state-by-state breakdown as well as stats for cases where the mid-level was supervised. I'd be curious to see how often supervised mid-levels are initially named then dropped when the lawyers realize they can easily win a case against a physician for 2-3x the payout in a fraction of the time and minimal effort.
 
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Stagg737 said:
Of course it's not a slam dunk, but it is a good starting place. I agree that I'd like to see a state-by-state breakdown as well as stats for cases where the mid-level was supervised. I'd be curious to see how often supervised mid-levels are initially named then dropped when the lawyers realize they can easily win a case against a physician for 2-3x the payout in a fraction of the time and minimal effort.
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A good starting place for systematically looking at outcomes? Sure. A good starting place for what the OP is proposing, not so much. Look, I'm all with you, I refuse to see midlevels for almost all of my healthcare, with the exception of if I were to need something really quickly from say, CVS/Walgreen's. But, trying to partner with the insurance industry to drive up costs for midlevels and try to put the independent practice horse back in the barn is likely an expensive and Quixotic endeavor.
 
WisNeuro said:
A good starting place for systematically looking at outcomes? Sure. A good starting place for what the OP is proposing, not so much. Look, I'm all with you, I refuse to see midlevels for almost all of my healthcare, with the exception of if I were to need something really quickly from say, CVS/Walgreen's. But, trying to partner with the insurance industry to drive up costs for midlevels and try to put the independent practice horse back in the barn is likely an expensive and Quixotic endeavor.
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True, I was just responding to your post about where the data was. There is some that exists, at the very least as a foundation that suggests the more research would be worthwhile.

Idk that the horse is out of the barn, or that it's at least not futile. Idk that lobbying with insurance is the way to go, but there've been more than a few successes at the local and state level in blocking FPA bills or limiting what can be done without supervision. I don't think it's futile in many locations and I do think it would be possible to continue blocking FPA in certain states or at the very least increase the ridiculously low standards and requirements needed to become licensed.
 
Stagg737 said:
Idk that the horse is out of the barn, or that it's at least not futile. Idk that lobbying with insurance is the way to go, but there've been more than a few successes at the local and state level in blocking FPA bills or limiting what can be done without supervision. I don't think it's futile in many locations and I do think it would be possible to continue blocking FPA in certain states or at the very least increase the ridiculously low standards and requirements needed to become licensed.
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I think the standards issue is probably much more feasible than the independence issue. As the dominoes fall, it becomes easier to sell that legislation. We've seen it here in a few areas with midlevels over the past several years. You can get a seat at the table, but it's unlikely that you'll stop it completely. You just have to decide how much money and time you want to spend delaying it.
 
Why would this be helpful? Isn't it the job of the underwriter to assess risk already? Wouldn't they be doing that with NP and PA malpractice coverage? If they are regularly sued and have higher payouts, isn't their coverage going to cost more, like say the difference between a dermatologist and a OB/Gyn? There are independent practice rights in enough states for underwriters to have access to excellent data, at least for NPs. I really don't see any PAs in psych, at least in my area.
 
WisNeuro said:
I think the standards issue is probably much more feasible than the independence issue. As the dominoes fall, it becomes easier to sell that legislation. We've seen it here in a few areas with midlevels over the past several years. You can get a seat at the table, but it's unlikely that you'll stop it completely. You just have to decide how much money and time you want to spend delaying it.
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We should gain some inspiration and momentum from oral surgeons: "Lobbying through malpractice insurance is actually pretty clever. My cousin went to dental school and then did a 3 year dental anesthesia specialization (very small specialty apparently) and he relayed to me that during a long bitter turf war with the Oral Surgeons...that the surgeons were able to lobby and pass something (i think in only one state) that increased malpractice coverage only for the dental anesthesia field...the increase was so significant though, that it prevented them from realistically practicing. Pretty genius."
 
In the very least we should all join physicians for patient protection. We need a unified lobbying force with a focus on increasing restrictions for ancillary professional practice especially in hospitals and nursing homes. If they want to open independent private practice that's fine. People can do their hw and make an informed choice to see them. What's been happening is that vulnerable populations in nursing homes and hospitals don't get that choice. This should be illegal
 
psychic_hearts said:
We should gain some inspiration and momentum from oral surgeons: "Lobbying through malpractice insurance is actually pretty clever. My cousin went to dental school and then did a 3 year dental anesthesia specialization (very small specialty apparently) and he relayed to me that during a long bitter turf war with the Oral Surgeons...that the surgeons were able to lobby and pass something (i think in only one state) that increased malpractice coverage only for the dental anesthesia field...the increase was so significant though, that it prevented them from realistically practicing. Pretty genius."
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Can you cite that specific example? I am curious if it has since come under lawsuits and appeals as it could fall in the realm of restriction of practice. I think you'll have a hard time doing this for nursing home stuff. Those positions are not exactly hot commodities, and anything that makes those spots harder to fill than they already are isn't exactly going to sell well in state legislatures.
 
Stagg737 said:
A little old, but relevant:

SAGE Journals: Your gateway to world-class research journals

Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.
journals.sagepub.com journals.sagepub.com

Compares malpractice reports and adverse actions between physicians, NPs, and PAs from 2005 to 2014. Figure 1 shows number of malpractice reports against physicians decreased by 11.5% (2,100 reports less) while PAs increased by 128% (366 reports) and NPs increased by 123% (255 reports). Nothing conclusive that should dictate policy, but some interesting info.

Another report from 2017 specifically comparing malpractice cases and outcomes for NPs from 2012 to 2017 showing significantly worse outcomes with some interesting shifts possibly suggestive that less supervision may play a role (my take, not stated in report):

Click to expand...
Thanks for posting this. It is a great start! I envision malpractice rates will go up for NPs and PAs regardless of our lobbying efforts. Keep hearing news stories of NP independent practice related deaths. I don't get why we cant just take this to supreme court and butcher this all at once. Why the *** do we need to go through the slow lobbying process while deaths rack up
 
psychic_hearts said:
We should gain some inspiration and momentum from oral surgeons: "Lobbying through malpractice insurance is actually pretty clever. My cousin went to dental school and then did a 3 year dental anesthesia specialization (very small specialty apparently) and he relayed to me that during a long bitter turf war with the Oral Surgeons...that the surgeons were able to lobby and pass something (i think in only one state) that increased malpractice coverage only for the dental anesthesia field...the increase was so significant though, that it prevented them from realistically practicing. Pretty genius."
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Absolutely. We should be joining efforts with other physicians on this and lobbying hard. It's getting ridiculous.

@WisNeuro why not the supreme court?? Your responses to this thread are kind of odd. Are you a psychiatrist?
 
Seroquel said:
Absolutely. We should be joining efforts with other physicians on this and lobbying hard. It's getting ridiculous.

@WisNeuro why not the supreme court?? Your responses to this thread are kind of odd. Are you a psychiatrist?
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No, but I am someone who actively works in legislation at the state and federal level. If odd=pragmatic, sure. So yes, tell me why the SCOTUS And can you outline how exactly you plan to get this to the Supreme Court. I think some people are incredibly naive as to how things actually work when it comes to state and federal statutes.
 
There are lots of NPs/PAs/Pharmacist groups actively lobbying for more independence so there is no reason why physicians cannot actively protect our profession. At this point it seems much of the fight is going on state by state but perhaps that will change. In any case, I think it's smart for psychiatrists to be more involved in PPP and similar groups who are doing this. And yeah, I don't use the term provider since it is so vague.
 
WisNeuro said:
Can you cite that specific example? I am curious if it has since come under lawsuits and appeals as it could fall in the realm of restriction of practice. I think you'll have a hard time doing this for nursing home stuff. Those positions are not exactly hot commodities, and anything that makes those spots harder to fill than they already are isn't exactly going to sell well in state legislatures.
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I worked as a nurse prior to being a physician. I can tell you that nursing diagnosis are not even close to medical diagnosis. I can also tell you that the advanced nursing degrees are fluff. I am passionate about this issue because of my first hand experience as a nurse who became a physician. No offence WisNeuro but you strike me as a bot.
 
psychic_hearts said:
I worked as a nurse prior to being a physician. I can tell you that nursing diagnosis are not even close to medical diagnosis. I can also tell you that the advanced nursing degrees are fluff. I am passionate about this issue because of my first hand experience as a nurse who became a physician. No offence WisNeuro but you strike me as a bot.
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No offense, but you strike me as someone who knows nothing about legislation or the law. As far as your ad hominem bot nonsense, there are people on here who can vouch for me personally. Who have trained and worked with me. How about discussing the ideas rather than throwing out childish nonsense?
 
WisNeuro said:
No offense, but you strike me as someone who knows nothing about legislation or the law. As far as your ad hominem bot nonsense, there are people on here who can vouch for me personally. Who have trained and worked with me. How about discussing the ideas rather than throwing out childish nonsense?
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Way to spend your time naysaying on the internet all day. I don't personally care about anyone vouching to prove you aren't a bot. And here's some grounds and momentum (unless you want to keep naysaying and calling me names):

Let's contact multiple professional organizations (American medical association), American psychiatric association, PPP and flood them with requests to take action against NP/PA independent practice. Hospitals and nursing homes have abused this to the extent of leaving NPs in charge of Emergency rooms without any physician supervision. Patients are not given the education to make informed choices on who is providing their care, least all of patients with neurocognitive disorders in nursing homes. NPs can open all the Botox clinics and independent practice they want (which is what they're doing, not serving remote populations like they claim to solve any shortages) but even there, they should make their title clear to provide patients and informed choice on who to see eg a dermatologist/dentist who is a specialist vs someone with a potential online "doctorate" with a focus on policy/lobbying for their toxic organization

Lots of malpractice going around:

$6.1M Oklahoma Medical Malpractice Verdict For Death Of 19-Year-Old In ER - Medical Malpractice Lawyers


How about the news today of the psych NP telling their suicidal patient whom they were engaged in sexual relationship with to not go to a hospital:

www.dailymail.co.uk

Stevie Ryan had relationship with nursing practitioner before suicide

Stevie Ryan, an actress and comedian who gained fame on YouTube with impersonations of celebrities, committed suicide in her Los Angeles home back in 2017 at the age of 33.
www.dailymail.co.uk www.dailymail.co.uk
 
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Medical licenses are like vaccines. They generally work well to keep the public safe, to the point where the public takes for granted what it was like in the bad old days where anyone could set up shop and unleash themselves on the public.

Maybe we need to abolish all licenses and let anyone and everyone practice medicine. I imagine after a few years, the pendulum will swing back toward public and political outcry for properly trained and licensed professionals.
 
"
Tbf it doesn't have to be a constitutional issue that comes before the court. *Jung v AAMC* was about antitrust practices/monopolies in the resident physician labor market.

You could potentially have a similar lawsuit as the various MBA-run orgs that want to churn out profit have a vested interest in promoting midlevels at the expense of physicians. This could be argued as creating an anticompetitive environment against physicians."

If no federal grounds for a lawsuit then in least demanding our professional orgs propose plans for handling mid-level encroachment or all future memberships will go to "physicians for patient protection" instead. Petitions can be made demanding this. Surveys can be made asking "would you renew membership to APA if they don't propose plans for handling mid-level encroachment?" Why give $$ to APA if they are doing nothing to lobby for physician interest in this matter. I do think the best bet is working to increase malpractice rates for ancillary professionals (insurance industry should lobby for this even without any physician effort) as a means of regaining supervision. Supervision could be a loophole
to prevent the higher rates for NPs, PAs or prescribing psychologist for that matter
 
Think through the anti-competitive issue. In many places, large care systems have a hard time recruiting physicians, particularly in certain specialties, psychiatry being one of them. The numbers and situation would actually support the NP/PA lobby in this issue. How would you justify that there is an issue with compettition, when there is actually a shortage and it's incredibly easy to get a job? I'm being serious here, how would you argue this to a state representative for statute changes, much less the supreme court? When that state rep tells you that the CMHCs can't recruit people, and now you want to make it even harder for them to find providers?

BTW, this is not hypothetical. We're currently working on a Human Services bill with psychiatry at the state level that has to deal with midlevels in certain agencies, particularly those with hard to fill positions. And we're a desirable metro area. It's all good and dandy to have grand ideas, but I would urge you to get involved with your state org to see how this stuff actually look in practice.
 
WisNeuro said:
Think through the anti-competitive issue. In many places, large care systems have a hard time recruiting physicians, particularly in certain specialties, psychiatry being one of them. The numbers and situation would actually support the NP/PA lobby in this issue. How would you justify that there is an issue with compettition, when there is actually a shortage and it's incredibly easy to get a job? I'm being serious here, how would you argue this to a state representative for statute changes, much less the supreme court? When that state rep tells you that the CMHCs can't recruit people, and now you want to make it even harder for them to find providers?

BTW, this is not hypothetical. We're currently working on a Human Services bill with psychiatry at the state level that has to deal with midlevels in certain agencies, particularly those with hard to fill positions. And we're a desirable metro area. It's all good and dandy to have grand ideas, but I would urge you to get involved with your state org to see how this stuff actually look in practice.
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If no federal grounds there are plenty of very good suggestions I have made in things that are a lot more realistic and will likely inevitably happen eg the malpractice rates going up. I think we need to hold professional orgs accountable for how they will address this and provide them surveys and petitions to start addressing it or, again, they're gonna lose their members to PPP
 
Candidate2017 said:
Medical licenses are like vaccines. They generally work well to keep the public safe, to the point where the public takes for granted what it was like in the bad old days where anyone could set up shop and unleash themselves on the public.

Maybe we need to abolish all licenses and let anyone and everyone practice medicine. I imagine after a few years, the pendulum will swing back toward public and political outcry for properly trained and licensed professionals.
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There have been very specific advancements in the field of medicine but not necessarily among doctors that have increased longevity, for example antibiotics, new cancer treatments, and surgeries.

Medical licensure has existed for centuries, at least since the early 1800s in the US, and if you look even at recent history the treatments have been beyond bizarre with specious reasoning. Medical error is still a large cause of death (some estimates as the third leading cause). I don't want to derail the thread by going into specific treatments, but if you look at the 1950s and before, when doctors were fully licensed, there were some really bizarre practices going on. The proof of them is in the medical journals of these licensed professionals.

The bad old days clearly overlaps with the days of licensure. And I'm not sure that the bad old days are over. It seems like there has been a relatively short period of truly evidence-based medicine, but even that is thwarted in various ways.
 
psychic_hearts said:
If no federal grounds there are plenty of very good suggestions I have made in things that are a lot more realistic and will likely inevitably happen eg the malpractice rates going up. I think we need to hold professional orgs accountable for how they will address this and provide them surveys and petitions to start addressing it or, again, they're gonna lose their members to PPP
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Professional orgs have to operate within the bounds of state and federal statutes. Those are the people that need to be convinced for some of these changes. Things can sound very good in a clinical context, but the transfer to the legal context is a completely different ballgame. Seriously, join your state org, you may be surprised at how much they are already doing legislatively in these areas. At any given time we have about 7-10 bills we're working on, some with overlap with the state psychiatry assn. There is a very real issue of balancing financial and political capital. Talk to some people who do this on a regular basis.
 

Here is a search engine to directly reach out to insurance lobbyists for your state. Thanks for posting data Stagg737. I am including your data summary in my emails alongside the links to the malpractice cases. I'm going to start compiling data as I would recommend others do as well so we can create our own research to use for lobbying
 
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psychic_hearts said:
How about the news today of the psych NP telling their suicidal patient whom they were engaged in sexual relationship with to not go to a hospital:

www.dailymail.co.uk

Stevie Ryan had relationship with nursing practitioner before suicide

Stevie Ryan, an actress and comedian who gained fame on YouTube with impersonations of celebrities, committed suicide in her Los Angeles home back in 2017 at the age of 33.
www.dailymail.co.uk www.dailymail.co.uk
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I agree with your point and I also agree about this psych NP being an idiot, but this isn't a difference between NPs and MDs. There are plenty of MDs and DOs who've been disciplined for inappropriate relationships with their patients and when it comes to suicide, there are a lot of docs held accountable for that too (and we don't know the extent of his culpability). The part about him telling her not to go to the hospital came from what she told a friend. We don't know what he actually said to her and what her suicidality was like at the time. There are a lot of patients out there with chronic suicidality. They do not belong in the hospital most of the time.

If we want to win the argument that MD > NP, then we need to focus on their knowledge base and how lack of medical knowledge and experience makes them more likely to make mistakes with meds.
 
Mass Effect said:
I agree with your point and I also agree about this psych NP being an idiot, but this isn't a difference between NPs and MDs. There are plenty of MDs and DOs who've been disciplined for inappropriate relationships with their patients and when it comes to suicide, there are a lot of docs held accountable for that too (and we don't know the extent of his culpability). The part about him telling her not to go to the hospital came from what she told a friend. We don't know what he actually said to her and what her suicidality was like at the time. There are a lot of patients out there with chronic suicidality. They do not belong in the hospital most of the time.

If we want to win the argument that MD > NP, then we need to focus on their knowledge base and how lack of medical knowledge and experience makes them more likely to make mistakes with meds.
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Exactly, and it will need to be done with actual data, not anecdotes if you want to make legislative changes. But even with this, I'd wager you have some other hurdles to clear with legislators.
 
WisNeuro said:
Think through the anti-competitive issue. In many places, large care systems have a hard time recruiting physicians, particularly in certain specialties, psychiatry being one of them. The numbers and situation would actually support the NP/PA lobby in this issue. How would you justify that there is an issue with compettition, when there is actually a shortage and it's incredibly easy to get a job? I'm being serious here, how would you argue this to a state representative for statute changes, much less the supreme court? When that state rep tells you that the CMHCs can't recruit people, and now you want to make it even harder for them to find providers?

BTW, this is not hypothetical. We're currently working on a Human Services bill with psychiatry at the state level that has to deal with midlevels in certain agencies, particularly those with hard to fill positions. And we're a desirable metro area. It's all good and dandy to have grand ideas, but I would urge you to get involved with your state org to see how this stuff actually look in practice.
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CMHCs can't fill because they pay crap and your patient caseload is very, very sick. No one wants to do it when they can set up shop across the street, easily get paid 100K more and see patients who aren't all that sick. Pushing more NPs into the system is not going to solve the problem with CMHCs not filling.
 
Mass Effect said:
CMHCs can't fill because they pay crap and your patient caseload is very, very sick. No one wants to do it when they can set up shop across the street, easily get paid 100K more and see patients who aren't all that sick. Pushing more NPs into the system is not going to solve the problem with CMHCs not filling.
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I'd talk to your state's dept of health, some of their numbers would actually show that they can indeed staff more easily with midlevels.
 
WisNeuro said:
I'd talk to your state's dept of health, some of their numbers would actually show that they can indeed staff more easily with midlevels.
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What numbers? Unless midlevels are being educated and trained with the distinct purpose (i.e. restriction) of working in a CMHC, they're not going to flock to them. Believing that saturating the industry with NPs to fill CMHCs is naive.
 
Mass Effect said:
What numbers? Unless midlevels are being educated and trained with the distinct purpose (i.e. restriction) of working in a CMHC, they're not going to flock to them. Believing that saturating the industry with NPs to fill CMHCs is naive.
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Staffing reports from CMHCs. We're dealing with this currently as they wish to reduce some statutes requiring certain doctoral level providers. What we believe is irrelevant to legislators. It's simply a better story to say that access to more providers is better than less access to providers in terms of hard to fill positions.

To clarify, I am not advocating for expansion of midlevel scope in any profession. I am merely letting you know how these things actually look when you are engaging in law changes at the state and federal levels. I'd love to tighten restrictions around scope of doctoral level vs masters level providers, but some of these ideas are just naive to how this looks when working with legislators.
 
WisNeuro said:
Staffing reports from CMHCs. We're dealing with this currently as they wish to reduce some statutes requiring certain doctoral level providers. What we believe is irrelevant to legislators. It's simply a better story to say that access to more providers is better than less access to providers in terms of hard to fill positions.

To clarify, I am not advocating for expansion of midlevel scope in any profession. I am merely letting you know how these things actually look when you are engaging in law changes at the state and federal levels. I'd love to tighten restrictions around scope of doctoral level vs masters level providers, but some of these ideas are just naive to how this looks when working with legislators.
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Ok, so you're saying that theoretically, if we allow NPs to work at CMHCs, they will. And I'm saying no they won't. You can change the laws however you wish. It doesn't mean that NPs are suddenly going to flock to CMHCs. I'd be curious to hear more about the staffing reports you're hearing/seeing.
 
Mass Effect said:
Ok, so you're saying that theoretically, if we allow NPs to work at CMHCs, they will. And I'm saying no they won't. You can change the laws however you wish. It doesn't mean that NPs are suddenly going to flock to CMHCs. I'd be curious to hear more about the staffing reports you're hearing/seeing.
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No, I'm saying, telling a state legislator that you want to limit the number of eligible providers to work in a clinic setting in which they have a hard time filling, legislators are going to be much more likely to see things according to the NP lobbying group.

As far as the staffing and other similar reports, these are going to be specific to your jurisdiction. Discussions formally and informally with legislators who are members of relevant committees and/or signed on to certain bills.
 
I am not sure if emailing insurance industry lobbyists is way to go about this as have no experience in this matter. Will require more research but have a letter drafted below and if anyone has suggestions on how to go about this please let me know:

Directory of lobbyists

"Dear _____


I am a medical resident and am interested in promoting the idea of further increase of malpractice coverage requirements for ancillary professions such as nurse practitioners that now have independent practice. This journal article:

SAGE Journals: Your gateway to world-class research journals

Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.
journals.sagepub.com journals.sagepub.com

compares malpractice reports and adverse actions between physicians, NPs, and PAs from 2005 to 2014. Figure 1 shows number of malpractice reports against physicians decreased by 11.5% (2,100 reports less) while PAs increased by 128% (366 reports) and NPs increased by 123% (255 reports).

A report from 2017 specifically comparing malpractice cases and outcomes for NPs from 2012 to 2017 shows significantly worse outcomes with some interesting shifts possibly suggestive that less supervision may play a role.

These ancillary professionals have poor, non-standardized medical training to handle the positions they are put into yet are now working independently. Many of their degrees are through online diplomas and only a fraction of the education/training required by physicians to practice. Accordingly, their malpractice rates should be 2-3 times higher than a physician unless they are supervised by a physician, as was the long standard.

While numbers speak more than anecdote and the research posted is but the tip of the iceberg, here is one of an increasing number of malpractice cases that demonstrate how nurse practitioner lack of medical training increases the risk of patient sentinel events:

medicalmalpracticelawyers.com

$6.1M Oklahoma Medical Malpractice Verdict For Death Of 19-Year-Old In ER - Medical Malpractice Lawyers

medicalmalpracticelawyers.com medicalmalpracticelawyers.com


Thanks for your consideration!"


Thoughts guys? Yes we can compile more data but this is a start
 
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Stagg737 said:
A little old, but relevant:

SAGE Journals: Your gateway to world-class research journals

Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.
journals.sagepub.com journals.sagepub.com

Compares malpractice reports and adverse actions between physicians, NPs, and PAs from 2005 to 2014. Figure 1 shows number of malpractice reports against physicians decreased by 11.5% (2,100 reports less) while PAs increased by 128% (366 reports) and NPs increased by 123% (255 reports). Nothing conclusive that should dictate policy, but some interesting info.

Another report from 2017 specifically comparing malpractice cases and outcomes for NPs from 2012 to 2017 showing significantly worse outcomes with some interesting shifts possibly suggestive that less supervision may play a role (my take, not stated in report):

Click to expand...
This.
 
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