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After the Match

After the Match

Boosting Profits Drives NP Diploma Mills

Cook, Thomas MD; Adler, Jason MD

doi: 10.1097/01.EEM.0000734568.43890.d0
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    NP, PA, APPs
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    Roughly 14,000 emergency nurse practitioners (and approximately 10,000 physician assistants) are working in EDs, providing a significant amount of emergency medical care in the United States. But, as we know, this is problematic for many reasons, and now the bar is sinking lower.

    Every single person who applied to a nursing master's program in the fall of 2019 was admitted, according to a U.S. News and World Report article. (June 9, 2020; http://bit.ly/2LGhVgB.) Nationally, the average acceptance rate for nurse practitioner programs is 66 percent. The lowest is six percent at the University of California-Irvine, but the article lists 20 programs that accepted all applicants, half of which had fewer than 30 contenders.

    The lowest number of applicants was at the University of the Incarnate Word in San Antonio. The tuition for a doctor of nurse practitioner degree is $950. Several schools on the list are less well-known, but many are recognizable, including Drexel University (17 students, tuition $1002), the University of Iowa (11 students, tuition $2235), the University of Maine (21 students, tuition $1466), and the University of Utah (28 students, tuition $1599). (U.S. News and World Report. June 9, 2020; http://bit.ly/2LGhVgB.)

    The most interesting of these programs is at Purdue University Global in Illinois. The school is accredited by the “Higher Learning Commission,” and is part of the “Renowned Purdue University System,” according to its website. Purdue University Global had 500 applicants in 2019, and all were accepted, according to the U.S. News article.

    It's one thing to appropriately vet a small number of applicants, all of whom presumably have at least a few years of clinical experience, but interviewing more than 3000 medical students for residency training over the past 20 years has taught me that it would be difficult to evaluate 500 applicants adequately in a single year. And how could they all be qualified?

    Another article, “The Best Online RN-to-DNP Programs 2020,” was published on the website NurseJournal.org. (Dec. 21, 2020; http://bit.ly/38if3iU.) Unlike U.S. News, an established source of reputable journalism, this website notes that it “generates revenue through advertisements for degrees and programs from certain schools,” and that “[t]hese institutions may pay us for student referrals whenever a site visitor uses the program search tool or interacts with advertisements located throughout the site.”

    Reading the fine print, you find that “Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us.” The article is composed by “Staff Writers,” but is labeled “ADVERTISEMENT” under that in a much smaller font.

    The article mentions that the median average wage for an NP is $115,800, and encourages viewers to use their search engine for a program that meets their needs. (http://bit.ly/3np8PC1.) What is immediately noticeable about some of the programs that are displayed is price. One school called the United States University advertises a master in science of nursing to become a family nurse practitioner for $27,000. (http://bit.ly/3hSkpEH.)

    I am not a hater; I work with nurse practitioners and physician assistants, and they are valuable members of our team. I do not have a vendetta against all advanced practice providers (though I receive emails accusing me of that). Instead, I want to point out the slippery slope on which we find ourselves. We have heard for decades about the physician shortage and subsequent lack of health care access for millions of citizens, and numerous medical schools (particularly osteopathic schools) opened to create more healers in response.

    Innovative thinkers came up with the idea to allow experienced nurses the opportunity to do more with their clinical know-how. It stands to reason that if you hang around doctors treating patients, some of their knowledge will rub off. None of this is crazy, but it opens Pandora's box.

    Hundreds of variables are in the equation to find some balance, but in the end, the common denominator is money. It is why experienced nurses often pursue these degrees and why educational institutions suddenly become more interested in teaching health care. It is why physicians and their professional organizations try to limit APP access to the job market by putting up administrative, regulatory, and political barriers to protect their income.

    It is also why lobbyists working on behalf of nurse practitioners push in the opposite direction. All of these proclaim they have the patients' best interests at heart, but this situation is clouded by numerous personal agendas.

    Putting all of that aside, however, consider the following scenario. What would be the reaction to a group of medical schools that accepted everyone who applied? What about schools for nuclear engineers that did the same? What if some police academies did this? Add to this that their education would be mostly or entirely online. Wouldn't this be considered irresponsible or even reckless?

    Of course, the answer is yes. Yet, in the drive to control health care costs and maximize profits, we overlook quality and accountability in a service industry that affects individuals, communities, and populations in the most profound manner possible.

    Dr. Adleris a practicing emergency physician at the University of Maryland Medical Center, where he serves as the director of compliance and reimbursement. he is also the vice president of practice improvement at Brault Practice Solutions, where he oversees provider education and group practice analytics. Follow him on Twitter@ercoderguy. Dr. Cookis the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter@3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.

    Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
    • hrizvimd5:18:39 PMIn response to pa2ed: If overutilization is permitted by the hospital administration, then with self-regulation, there is no oversight. I have observed this randomly. No one being held to account is why PAs are exposed to cases they are not prepared to handle. It's the same for volume--a total loss of quality control. The midlevel has been turned into a billing monkey, dancing to the tune of the administration. It is a collapse of quality and professional ethics when midlevels answer to the employer. The local administrator is the overlord running a fiefdom.
    • pa2ed5:10:24 AMWhat exactly is the PA self-regulated industry?
    • davist4:24:46 PMI worked as a PA for 15 years before going back to medical school and learned that supervision is essential from my program. I functioned well in an underserved environment with the support of amazing physicians who mentored me. My significant other is an NP, and I watched him get his master's through an online program. (And was horrified at how basic it was.) There is a vast gap in knowledge between APPs and physicians. I use this additional knowledge every day on the job. It isn't part of a "turf war" to say supervision is necessary. Supervision is essential for patient safety.
    • hrizvimd3:37:16 PM<p>Response to comment by Ms. Ballard&#58; The PA self-regulated industry has allowed PA utilization to be exploited. Most everyone will hesitate to confirm this politically incorrect view, but PAs are putting themselves in a position to work with token supervision or no supervision, so they have participated in wholesale fraud on the public. A true professional exercises independence from the hospital industry. PAs don’t; they serve their hospital industry employers. PA help is needed, but not if you collect lavish salaries and employment deals that replace attending physicians and in the process of deprive patients. PAs are unprepared to function independently; they do not have the academic basis. Same for nurse anesthetist, midwives, and optometrists in direct clinical services.</p>
    • shannonballard504:22:31 PMI appreciate you shedding light on this issue, and I agree with this article wholeheartedly, with one exception&#58; You are lumping PA standards in with NP standards. This is very inappropriate. PAs follow a completely different training model, so though we could both be categorized as APPs, it is unfair to make it appear that PAs have slackened their standards when in truth the only evidence presented demonstrates that NPs have. We are two different professions. Please categorize us separately.
    • ntmoore4:09:00 PM <p> &#160;&#160; I lost my full-time job after I trained my replacement, a PA. I was told they are better because they do not cost as much. It is all about money, not quality, and it is getting worse. Look at all the PA and NP schools popping up all over the place. I am boarded in emergency medicine for 30 years, and my boards are current. I staff PAs and NPs. You would not believe how many people were saved due to my input on care! I am not perfect, but it is appalling because I see how poorly educated many of the midlevels are!!!</p>