An excerpt from Imposter Doctors: Patients at Risk.

On December 17, 2020, television network WGN America featured the book Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare in a news segment entitled, “Families sound alarm on medical transparency after deaths of their children.” The American Association of Nurse Practitioners (AANP) was desperate to keep the public from seeing this news piece. The advocacy group worked frantically, issuing a call to action to its 121,000 members, urging them to inundate WGN with phone calls, emails, and social media messages demanding that the station pull the broadcast. An email written by AANP president Sophia Thomas read,

I have an urgent request. We need your help to contact WGN America, News Nation using Facebook, Twitter, email, and phone to pull an irresponsible news story by reporter Rich McHugh that maligns NP care.

The story is scheduled to air tonight around 7 p.m. This news piece suggests that NPs are unsafe providers who are unqualified to provide care. The storyline parrots the recent book by Physicians for Patient Protection President Rebekah Bernard and a coauthor.

This piece has the potential to reach millions of households nationwide. I was interviewed for this story, and the reporter’s bias was clear. We have worked together to stop irresponsible journalism before. We need your action immediately today.

The message was followed by contact information for WGN, including the network’s phone number, email address, website, and even direct contact information for WGN executives. It included this sample phone message:

Shame on you, WGN. Pull this irresponsible story from Rich McHugh. You are maligning NPs working on the frontlines of a pandemic. NPs’ outstanding safety track record is backed by decades of research. News should be free of bias.

A sample Tweet suggestion read:

Your news promo on NP care is irresponsible and clearly biased. Pull this story. You should be ashamed of maligning frontline health care workers when patients need more care, not less.

Despite the AANP’s aggressive actions, WGN aired the segment, prefacing the report with a mention of the techniques used by the organization. Journalist Rich McHugh pulled no punches, challenging Sophia Thomas with some of the toughest questions facing the nurse practitioner profession today. He began with a question that is far more complex than it seems at first light: “Do nurse practitioners practice medicine?”

Nurse practitioners are registered nurses who complete an additional two years of training, which includes a minimum of 500 hours of clinical experience. To be licensed to practice medicine, physicians must complete a minimum of 7 years of training, including 15,000 hours of clinical experience. Because of these differences, nurse practitioner advocates often state that rather than practicing medicine, NPs practice’ advanced nursing.’

Thomas took a different tack, answering, “Nurse practitioners practice health care.”

McHugh’s brows furrow. “But I’m confused,” he said. “If nurse practitioners are prescribing medicines and treating patients, aren’t they practicing medicine?”

Thomas’s reply: “I think the definition of medicine is changing.”

Indeed, the AANP has worked tirelessly for decades to expand the definition of medicine to incorporate care provided by nurse practitioners. Through strategic alliances and intensive lobbying efforts, nurse practitioners have successfully achieved ‘full practice authority,’ the right to treat patients without physician oversight, in about half the states of the Union, despite having just a fraction of the training of doctors.

McHugh asked Sophia Thomas if the AANP’s goal is for nurse practitioners to have full practice authority – “basically the ability to run their own practices in every state in America.”

Thomas answered in the affirmative, noting that this goal is supported by the Federal Trade Commission, the National Academy of Medicine, and National Governors Association. “They know and understand that NP practice and clinical outcomes are equal to our physician colleagues and NPs improve access to care,” she said.

While this messaging of ‘equal outcomes’ is a core AANP talking point, it fails to include an important caveat: studies comparing nurse practitioner care to physician care have always evaluated low-risk patients with known diagnoses. Further, these studies have invariably involved some degree of physician supervision.

Just as the definition of medicine is being stretched, research findings are being extrapolated to the point of illogic, with advocates arguing that if nurse practitioners can treat simple medical problems with physician assistance, they should have similar outcomes with complex patients and no physician oversight.

Advocates also fail to mention that the last large-scale analysis evaluating NP outcomes was published more than 20 years ago, and well before the rapid growth of nurse practitioner training programs pumping out poorly prepared graduates. Rich McHugh asked Sophia Thomas about the rise of such programs. “Would you agree that there is an issue with online diploma mills with regard to nursing schools right now?”

Thomas: “I think that there is an issue with—,” she paused. “There are a few non-accredited programs out there, and AANP doesn’t support programs that are not accredited.” Thomas tells McHugh that nurse practitioners need to graduate from an accredited program of nursing. “They are expected to meet certain core competencies and things like that,” she said.

As part of the news story, Rich McHugh interviewed the family of Alexus Ochoa, who died after receiving improper treatment by a nurse practitioner working alone in an emergency department. Alexus’s mother told McHugh that the nurse practitioner who treated Alexus introduced herself as a doctor, saying, “I am the attending physician.” It wasn’t until after Alexus’s death that the Ochoa family learned the truth.

Regarding this lack of transparency, McHugh asked Thomas if she had any issue with nurse practitioners inappropriately referring to themselves as a doctor. Thomas responded adamantly: “Doctor is an academic term. Doctor doesn’t mean physician and the physician world doesn’t own the term doctor.”

Rebekah Bernard is a family physician and the author of Imposter Doctors: Patients at Risk and How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession.