GUEST VIEW: Breaking up medical teams will not solve physician shortage

Dr. J. Lee Valentine

As a Mississippi-licensed board-certified family medicine physician, I’m very concerned about House Bill 613, which would remove the supervision requirement for advanced practice nurses collaborating with physicians.

I have been a Mississippi physician in family and emergency medicine for nearly four decades, and from this experience, I have great confidence in a team approach to healthcare — with that team being led by a physician. A team-based system offers the safest approach to medical care. By focusing on their unique skills, every member of the team plays an important role in providing high quality patient care.

I was proud to support the University of Southern Mississippi’s initiative to begin a Nurse Practitioner Program in the early 1990s. The idea was to expand the training of nurses to assist physicians in their practices because of the shortage of primary care doctors in rural settings in Mississippi. This was a great solution to improving access to health care for rural Mississippians.

The original plan was for nurse practitioners (NPs) to serve as physician “extenders,” which would allow the physician to take care of additional patients while the NP would handle appropriate complaints, follow up visits, and wellness exams. Under this approach, NPs were to instruct in diabetic management, and other important duties. Since NPs are trained in the nursing model, healthcare instruction and teaching would have been their forte and a huge asset to physician-led care.

However, not long after the population of NPs increased, some hospitals and clinics began using them as “providers,” working in the same capacity as physicians as opposed to being in the “extender” role as originally planned. Soon after, some NPs sought to be referred to as “providers” with the intent to practice medicine without medical school and residency experience.

Taking it a step further, a very vocal few — supported by organizations and resources from outside the state — are pushing to upend the proven, physician-led model of team-based healthcare, and I strongly believe this change will not be in the best interest of public health. The collaboration between physicians and nurse practitioners leads to superior patient outcomes and should be safeguarded. Medical school and residency training matter. Training a nurse and then training as an NP for an additional 18 months, possibly online, does not prepare NPs to handle the wide range of knowledge and experience necessary to practice the full scope of medicine.

Ideally, healthcare should be a team approach, led by the physician. Physicians value NPs as part of the team — they bring incredible skills to patient care. But specialty training and medical school training are essential to provide the best diagnosis and treatment for patients.

Unfortunately, well intended efforts to provide flexibility to NPs have set in motion a trend of some NPs pursuing practice without supervision. Mississippians want and deserve team-based care. A recent poll showed that more than 90 percent of Mississippians want physicians and nurses to work together. That is a powerful message.

As I mentioned earlier, the mission for training NPs in Mississippi was to better assist physicians in their practice because of the shortage of primary care doctors in our state. We still face a physician shortage, but breaking up high-functioning and effective medical teams is not the way to solve it.

Physician-led collaborative care is the best way to ensure Mississippians receive the health care they need. I am urging Mississippians who are concerned about patient health and the health of our state to contact their state representatives at 601-359-3770 to ask them to VOTE NO on House Bill 613. I also encourage people to learn more about the importance of keeping medical teams together at www.scopeofpracticems.org.

Dr. J. Lee Valentine is Board Certified in Family Medicine. He was the founding program director for the EC HealthNet Rural Family Medicine Residency Program in Meridian and presently serves as associate program director.

 

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