Update: Bill passes BUT it only expanded the limit to 75 miles. Senator Terry Burton offered a committee substitute that passed.
It is often reported that Mississippi is dead last in health care due to it being a poor state. However, it is the position of this website that crony capitalism and good ole boy rules limit health care access for many Mississippians as well. JJ reported recently that certificate of need laws limit health care while making it more expensive for those who can least afford it. Steve Wilson delves into the antiquated Nurse Practitioner rule over at Mississippi Watchdog. Nurse Practitioners can only operate within a 15 mile radius of their supervising physician. Such rules make perfect sense in rural areas such as the Delta where the poor are many and doctors are few. Mr. Wilson reported:
Nurse practitioner Christopher Fletcher works at a clinic in Picayune, Mississippi, where he sees patients and helps diagnose their illnesses, in collaboration with a local physician.
The doctor lives nearby. But if the M.D. moves, or retires, or dies, Fletcher would have just 90 days to find someplace else to ply his trade.
Under a four-decade old restriction, Magnolia State NPs cannot practice more than 15 miles away from their supervising physician. The law, say Fletcher and other critics of the restriction, limits access to care for patients and professional opportunities for nurse practitioners.
“It puts a severe limit on clinics with just a nurse practitioner,” Fletcher said.
State Sen. Angela Hill, who counts Fletcher among her constituents, is pushing a measure that would eliminate the 15-mile restriction and allow more clinics to be built in remote areas. Nurse practitioners would still have to work in collaboration with a physician under the bill.
Hill says the 15-mile limit is a crippling restriction in a rural state where many counties have one hospital. Only three states have such a restriction.
She also said doing away with the restriction would have the added benefit of reducing emergency room visits for minor ailments, because those patients could see a nurse practitioner instead.
“You would expand health care as far as access and you’d have business development too if you could have a nurse practitioner in a clinic more than 15 miles from a doctor,” Hill said. “You don’t need a doctor for everything. I’ve got some folks who want to build clinics throughout the state, but it’s just not cost-effective because they don’t have this rule in surrounding states.
“We’ve got telemedicine now, but we’ve got to have a nurse practitioner 15 miles from a doctor. That doesn’t make a lot of sense.”
The bill is in the Senate Public Health and Welfare Committee and will need approval by Tuesday’s deadline for bills to be out of committee.
Ryan Kelly, executive director of the Mississippi Rural Health Association, told Mississippi Watchdog that the measure would provide much-needed health care options for Mississippians.
“I think everyone agrees 15 miles is more restrictive than needed,” Kelly said. “I think people are realizing it needs to be abandoned because people need more access to health care in Mississippi. It’s just ridiculous how far people have to go to get access to health care. The only possible way is if you get really, really sick and you go to an ER. It’s a terrible way to treat patients and run a healthcare system.”
Standing athwart increased access to care is the Mississippi State Medical Association.
Communications officer Kristen Lucas told Mississippi Watchdog the organization opposes the bill because “collaboration between nurse practitioners and physicians is key to patient safety and quality of care. The distance requirement is in place to ensure that collaborative relationship is maintained.”
Fletcher called that notion “antiquated,” pointing out that most of his consultations with his collaborating physician are done via text message or phone call.
“With today’s technology, there’s no reason for a physician to be 15 miles from you,” he said. “The reality, in my experience, if the physician is not in the office with you and they’re within that 15 miles, if you’ve got questions or what not, you’re going to call them. It happens very rarely that they have to come to the clinic.”
Kingfish note: A nurse practitioner must have a master's degree in nursing. She can prescribe medications but must obtain a DEA number to prescribe narcotics and meet the same DEA requirements as a physician.
The 15-mile rule is nothing but good ole boy corporate welfare for doctors. The rule limits competition as well as access to health care. There is a shortage of doctors in the rural areas of the state. The shortage is so severe that representatives of the Aaron Henry Community Health Centers were begging the Medical Licensure Board last month to approve a limited medical license for a foreign doctor who failed part of his clinical board exams. Earlier post. The board approved the limited license. A 2008 Mississippi Business Journal article spells what the doctors' lobby thinks of Nurse Practitioners:
MSMA's president-elect Randy Easterling, M.D., practices family medicine and addiction medicine in Vicksburg where he does not have a nurse practitioner on staff. He also believes the state's patient/ provider ratio is frightening.The scuttlebutt around the legislature is that even if the bill passes the Senate, it will likely die in committee when it reaches the House. The bill would be assigned to the Health and Human Services Committee. One can easily guess who gives the most money to the chairman's campaign.
Filling a niche?
"Nurse practitioners fill a niche; mostly in rural Mississippi," he said. "If used appropriately, they don't dumb down the practice of medicine, but they must do what they're trained to do."
Easterling, who serves on the State Board of Medical Licensure, says the nurse practitioner movement is more than a growing trend in a state that graduates only 110 physicians each year and graduates three times that many nurse practitioners.
"I would like to see the medical school turn out more family physicians; that's the answer to the provider need, not more nurse practitioners," he said.
Magnolia family physician Luke Lampton oversees two nurse practitioners and admits that physicians can feel very strongly about them. He feels most physicians respect and admire nurse practitioners, but are very much against them being substitutes for physicians.
"Most will acknowledge their role but feel healthcare should center on the physicians," he said, "and most think it would not be good for healthcare to expand the role of nurse practitioners."