Posted by: Witch Doctor | May 11, 2009

A serious conflict?


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There may be several reasons for the nurse practitioner skipping up the steps to the very top of the skills escalator. The Witch Doctor has always felt that political expediency and the economic “requirement” to generate a market in healthcare is largely responsible for nurses being used to do work that was always considered to be within a medical practitioner’s job description.

Yes “used”.

In the same way she thinks that pharmacists are being “used” to create a market in health care.

By using nurses and pharmacists in this way there is an added advantage of clipping the wings of the politically powerful medical profession.

Many changes that are introduced in the UK have their origins in the USA where the “Dr Nurse” is now gathering momentum.

The woman behind the rise of the Dr Nurse movement in the USA is Mary Mundinger.


Here is a list of some previous posts regarding Dr Mundinger.

Now, when the Witch Doctor awoke this morning she found that a visitor from the USA had added a comment to an old post on this blog relating to Mary Mundinger. Since it is well hidden, here is what was said.

“Mary Mundinger, who recently resigned from her position as dean at Columbia School of Nursing where the doctoral program for nurses began, has arguably been the most aggressive advocate for replacing physicians with nurses.

There is more to the story. Over the years, there have been a number of conflicts of interest. Mundinger is entwined with corporate interests in the healthcare industry. She is on the Board of Directors of UnitedHealth Group, Welch Allyn, Gentiva Health Systems (nationwide provider of home health and nursing services), and Cell Therapeutics.

Mundinger has pushed for more power for advance practice nurses at the same time she has had a fiduciary duty to UnitedHealth Group and its stock-holders, and the similar duties to stock-holders of other companies.

Mundinger, a Director of UnitedHealth since 1997, HAS RECEIVED OVER 1 MILLION DOLLARS IN COMPENSATION FROM UNITEDHEALTH SINCE 2006 alone. As of December 2007, Mundinger held 32,000 shares of UnitedHealth stock.

How much of Mundinger’s aggressive advocacy to replace physicians with nurses is related to her duties to UnitedHealth insurance company and other healthcare corporations? Mundinger is a highly compensated director of organizations that could profit from her recommendations to replace physicians with less expensive (though not equivalently trained) nurses.

This issue is especially relevant given the U.S. Institute of Medicine’s recent report on conflicts of interest in medicine with its recommendations to remove industry influence from medical education and the development of practice guidelines.

Of concern is that Mundinger has not mentioned these important conflicts of interest in her academic articles and research reports. These reports have propelled the ‘nurse doctor’ movement. One wonders how much of Mundinger’s work reflects her professional and academic research and beliefs, and how much reflects her fiduciary responsibilities to commercial organizations.”

The original post is here.

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