1. Pearson, Linda J. RN, FNP, FPMHNP, MSN, DNSc, Editor-in-Chief

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Recently, the New York Times published an article describing the financial ruin of New York City's Mount Sinai Medical Center due to poor management on the part of its physicians and business chief executives. 1 Mount Sinai's budget deficit is growing so large that its bonds are in danger of a junk rating. As the hospital spirals deeper into debt, hundreds of essential hospital employees have been laid off, causing a quality care crisis. One state investigator found that a highly publicized liver transplant death was due to "woefully inadequate care".


Not surprisingly, the physician and business executive team claims that the fiscal crisis is due to overwhelming external forces beyond its control (e.g. dwindling government money and more uninsured patients).


Outside consultants for Mount Sinai cite fiscal laxity and excess as the real problems. Mount Sinai failed to bill Medicaid for outpatient visits on the flawed assumption that the reimbursement was too low to bother. Hospital operations were inefficiently run, and many tests were double-ordered by the medical school faculty. The attempted merger between Mount Sinai and N.Y.U. medical schools was seriously undermined by medical school faculty dissent. Deceptive 'window-dressing' accounting hid many of the problems, while keeping top physician and business executive salaries in the high six- and seven-figure range.


A Trend of Compromised Care

Reading the Mount Sinai article reminded me of other recent mismanagement and miscalculations involving physicians. In February, the American Academy of Pediatrics (AAP) published a new version of its policy statement on nurse practitioner (NP) practice. This sorrowful document takes the following stance: it opposes NP expanded scope of practice, NP independent prescriptive authority, NP reimbursement parity and NP independent practice. 2


What's Behind the Decisions?

Westley Bryne, DrPH, NP, The Nurse Practitoner 's 2002 NP of the Year, wrote to the lead author of the statement saying, "No clinician with whom I have practiced has ever voiced, much less acted on, the sentiments described in your statement. If any had, no doubt the practice would have come to a screeching halt[forms light horizontal]how many [clinicians] have the time, money, or capacity to assume responsibility for the care of their colleagues' patients in addition to their own, to oversee and coordinate all the care delivered, and to determine when referrals are warranted? ...The fact that two autonomous professions [nurses and physicians] overlap in many areas does not give either one of them the right to have decision-making powers in the other's domain."


The AAP claims that its policy statement is not motivated by competition but by an effort to maintain quality of care. 3 Despite this assertion, the AAP offers absolutely no scientific evidence-not even anecdotal reports-that ANY care has EVER been compromised by NPs who specialize in pediatrics.


Care is compromised, however, when arrogance and mismanagement drive executive decisions. Health care worker morale at Mount Sinai has suffered and patient satisfaction is down due to the mismanagement crisis. The AAP's insult has personally wounded many pediatric NPs. Care is bound to be compromised if it is delivered in an atmosphere devoid of collegiality and cooperation, and conducted in an environment of disdain.


We face an unparalleled crisis in almost every aspect of the health care system. Where is the wisdom behind the decisions and statements of highly compensated professionals that result in further exacerbation of this crisis?




1. Cowan AL: How mount sinai helped undermine its own health. The New York Times April 7th, 2003, available on-line:[Context Link]


2. Policy Statement - Scope of Practice Issues in the Delivery of Pediatric Health Care Pediatrics 111(2):426-435. [Context Link]


3. Croasdale M. Pediatric society opposes independent practice of NPs, American Medical News, March 10, 2003, p. 16. [Context Link]