An Open Letter to Medicine: Shame on the PPP

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Recently an organization called the “Physicians for Patient Protection” (PPP) put out yet another attack on the American Association of Nurse Practitioners® (AANP) and the nurse practitioner (NP) profession (“A Tragic Comedy of Errors”, January 5, 2020). In it, PPP-backed physicians make a series of assertions that include both inaccurate statements and rehashed well-worn attacks.

Given similar jibes from PPP the past several months, it appears that the organization exists to provide cover for those in medicine who are unwilling to attach their names to baseless allegations.

FACT: It is not just AANP that has called for full practice authority. This recommendation is contained in the Institute of Medicine report issued in 2010 and was more recently supported by the Trump Administration in its report, “Reforming America’s Healthcare System Through Choice and Competition,” a document signed by three cabinet secretaries. Further, the Administration issued a recent Executive Order, which calls upon the Secretary of Health and Human Services in Section 5 of that Order to remove barriers to practice within one year.

FACT: AANP has not mandated “that 100% of all practicing NPs obtain the Doctorate of Nursing Practice (DNP) within a specified period of time.” This is patently false. Not only has AANP not “mandated” it, we do not have the authority to do so. AANP has taken no official position on the issue.

FACT: The PPP suggests that quality has suffered because of the expansion of NP programs. This is not true. Programs have expanded because of educational and consumer demand. These programs receive certification through such organizations as the Committee on Collegiate Nursing Education. If the PPP has fact-based evidence to show that any of these programs are deficient, it should provide it.



FACT: In 22 states and the District of Columbia, NPs are granted full practice authority. In the remaining states, NPs are required to contract with a physician under the guise of “supervision” or “collaboration” and, in many cases, must pay a fee to the physician. This is not a health benefit to patients. It is an economic incentive for physicians to boost their incomes while squeezing the supply of providers available to patients.

FACT: Most NPs work collegially with physicians. Organizations such as PPP go on the offensive because they fear losing their economic stranglehold over health care.

The authors suggest several examples of what they believe to be inappropriate care by NPs. Rather than provide specific examples with the final dispositions of these cases in a well-documented fashion, they provide vague information with no specific facts. This is a very slippery slope for medicine, and with 7.4% of physicians experiencing a malpractice claim, compared to just 1.1% of NPs, PPP has no business pointing its collective finger at the care NPs provide. Not all clinicians are perfect, including physicians. It would be easy to find thousands of documented cases of physician malpractice, including citations from medical boards where physician licenses were suspended or revoked, as well as the disposition of medical malpractice cases where physicians have been sued for millions of dollars.

For a profession that defines itself based upon science and evidence, it is a shame that groups like PPP resort to ad hominem attacks on the NP profession out of fear of economic competition.



NPs, with a 50-plus year track record of high-quality, patient-centered care and more than 1 billion patient visits each year, represents the future of health care. Organizations like the Physicians for “Pocket” Protection — and their attacks aimed at hiding the truth and protecting medical monopolies — represent the past. Patients and taxpayers deserve better.