Thank you for the enlightenment!

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

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One more emergency, we need to face

This was a great summary of the disaster unfolding in every clinic in the United States right now.

The idea that lesser train people could handle. The job of. Physician was always ridiculous. But people involved in the money side of business only looked at the dollars. We have paid and will continue to pay the price for this shortsightedness. Thank you to the authors for a great summary of the problem.

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Shocking and Eyeopening

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

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

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One of the scariest nonfiction books published

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

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Eye-opening

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

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Revealing

I had heard the same NP talking points but hearing that the original studies showed NPs less safely managing patients, thus requiring oversight and not saving costs.

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Brutally Honest!

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

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

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A Must-Read Book

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

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Terrifyingly true!

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

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Well written book

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

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