Thursday, January 25, 2018

Freedom for Nurse Practitioners?

A little change to the nurse practitioner regulations is sure to ruffle some feathers in the medical community.  The Mississippi Board of Medical Licensure is considering removing the limit on how far nurse practitioners can work from their supervising physician.

The Board's regulations limit nurse practitioners to operating no more than 75 miles from their supervising physicians.  However, the radius was 15 miles until only two years ago.  The radius has been the topic of much debate as the medical community and politicians seek to expand access to health care in Mississippi.

Board President stated in a letter sent to Representative Sam Mims, Chairman of the House Public Health and Human Services Committee, that

The purpose of this letter is to inform you that the Board intends to take under consideration, and vote on, the attached draft regulation changes at our January 18, 2017, regularly scheduled meeting. I think you will find this language creates the changes requested in a manner that still ensures good collaboration between physicians and nurse practitioners as the law requires. As you will see, the changes allow for an exemption solely for primary care providers to the mileage requirements as stated currently...
The meeting was postponed until February 1 so the Board could respond to any bills that were passed by committees in the legislature. The proposed regulation to Rule 2630 states:

Rule 1.5 Primary Care Extended Mileage. Primary care physicians, as defined in Rule 1.2, shall have no mileage restrictions placed on the collaborative agreement between the physician and the nurse practitioner if the following conditions are met:

1. The collaborative agreement is between a primary care physician and a primary care nurse practitioner.
2. The physician is in a compatible practice (e.g., same specialty, treat the same patient population, etc.) with the nurse practitioner.
3. The physician utilizes electronic medical records (EMR) in their practice, and also utilizes EMR in the formal quality improvement program.
4. The physician practices within the State of Mississippi for a minimum of twenty (20) hours per week or eighty (80) hours per month.
All other requirements stated herein regarding collaborative agreements/relationships with nurse practitioners shall apply.
Kingfish note: This is a huge change from what the Board tried to pull two years ago.


Anonymous said...

I have come to the conclusion that nurse practitioners have way more clout than chiropractors.

Anonymous said...

In the electronic age, tethering nurses to a doctor based on miles is ridiculous.

Apparently, this board would rather rural communities do without access to health care and drive up health care costs rather than be bothered to learn how to function in this century.

And, God forbid , this board would even try to peek outside their tiny little box at the rest of the world is successfully doing.

Anonymous said...

It all boils down to the MDs maintaining a monopoly on the health care industry in MS. As a lot of people do, I know when I have a sinus infection or some other minor ailment, and when whatever that ailment is bad enough, I just need to have somebody write me a prescription. A NP can do that just as easily, and most of the time much quicker, than a MD can. I'm not discounting the importance of MDs, but they are not the most efficient group in delivering health care for the minor stuff. In areas where MDs are not readily available, we need to make it easier for NP to be able to practice. NP-provided health care is much better than no health care at all.

Anonymous said...

Seems like a prudent political move.

Anonymous said...

8:32, they are better trained also.

Anonymous said...

I'd rather be under the care of a NP and chiropractor any day over an MD exclusively. Maybe their schedules don't allow, but MDs don't seem to keep up with new information in nutrition and natural treatments. They're too tied in to pharmaceutical industry. Patients are the ones who suffer with unnecessary prescribed medications.

Anonymous said...

1233 please provide specifics regarding the nutritional and natural treatments.

Anonymous said...

Your obviously very uniformed about modern day medicine. That statement alone disqualifies you from any debate or educated discussion. Your what I thought of when I came here to practice medicine 10 years ago from out of state. It's unfortunate really that people are misguided as you are on these topics. I'm sure you Google search every word you are told at the medical clinic. Your an absolute dimwitt.

Anonymous said...

12:33 is nothing more than a troll... no way someone with any guidance can make such a statement.

Anonymous said...


"Your" practicing medicine here with obviously an elementary education.

Al Gore said...

This is why I invented the internet...

Anonymous said...

The NPs that I have seen are overprescribing branded drugs and have been targeted by pharma reps way more than doctors. The ones that are thinking outside the box are violating their scope of practice as well. Very little training and a monthly prescribing reference equals dangerous.

Anonymous said...

I go to my nurse practitioner instead of my Dr as much as I can. She is hot as hell. If I'm going to feel like crap, and get a basic prescription for a basic ailment,I might as well stare at a rock hard ass while I'm doing it.

Madison Doctor said...

@250 name please. Looking for a new nurse practitioner to collaborate with

Anonymous said...

Be careful what you wish for. The doctor's office is not more difficult to get in and out of because their office staff is somehow less capable than a nurse practitioner's-- it's because their practice is infinitely more complex-- for good reasons.

A nurse practitioner can get license with 5 1/2 years training. And that includes college. An MD-- even in Family Practice has to go through 4 years of college--and be near the top of their class-- 4 years of medical school and 4 years of internship/residency. That's 5 1/2 years of college and nursing school vs the absolute grind of 4 years of college and 8 years medical training, which is far more competitive, and intense than nursing school. There are rules (which most training programs ignore) that limit doctors in training from spending more than 80 per week at work-- and that doesn't count call hours or home studying. There is simply NO comparison in education.

But sure-- a nurse pract can give you a prescription of antibiotics (usually for a virus which is worthless) and you're out in no time. In fact, if you're really SICK chances are they are going to punt you to a real doctor for any illness that requires increased time, effort and education/experience to treat. So NPs get the "best" patient's-- the easy to diagnose, generally healthy, in-and-out quick ones, while the MD/Dos next patient could be a teenager with a cold (<10 minutes) or someone in the advanced stages of heart disease with new onset kidney failure (>1 hour). I wonder why the wait at a doctor's office is longer? And the NPs don't admit patients, take call or generally work holidays or weekends. What a job! And they can double or triple their income with just 18 months nurse practitioner training after finishing nursing school. What a deal!

The bottom line is that untethered NPs cannot possibly give the same level of care. True, they usually don't have to, but when all the easy patients (easy= quick,in/out, $$$, little work) go to NPs this leaves the doctors with difficult to manage schedules and very hard/intense work days. Is there any wonder why no one wants to go into Family Medicine anymore?

Admit it-- most of y'all who prefer NPs wouldn't mind seeing them replaced with vending machines where you dial in your symptoms (or make your own diagnosis), swipe your credit card and collect your drugs. Like the kiosk at the DMV.

Bottom line--someone has to have the back of a nurse. Unfortunately, the NPs have figured the system out, and are banding up and instead of doctors hiring nurses, nurses are hiring doctors to "assist" them. The reality is they pay someone to be a name on the chart and rarely if ever consult them.

Anonymous said...

Kiosk might be onto something there, 9:59.

Anonymous said...

12:41 - a couple of examples - rather than dangerous prescriptions for conditions such as high bp and cholesterol, suggest dietary changes, calcium, magnesium, fish oil, etc. And giving a nutritional directive to support the body during cancer treatment which prevents chemo and radiation from doing as much harm to healthy cells.

And "dimwitt" at 12:42, you misspelled "dimwit" and it's "you're" (thanks, 1:11). More seriously, it is against the law to pretend to be a doctor. Maybe they'll let you play on the television commercials - "doctor poses".

1:06, exactly just what kind of guidance qualifies you to call 12:33 a troll or make a statement on the practice of medicine? Pretending to be a doctor too?

2:50 and 8:51, maybe you haven't heard, sexual abuse isn't very popular these days. I'm sure we'll be hearing more about you two.

Anonymous said...

122 are you suggesting that calcium and magnesium supplements are effective treatments for

Ralph Huey. said...

It’s either the dopers or the all natural crunchy rainbow co-op crazies that make me laugh so much on this site. Go back to your all natural APN and take some or smoke (probably both) some herbs.

Anonymous said...

Is the Legislature going to believe the Board again? They did the same thing last year and lied to Senator Terry Burton!

Anonymous said...

If this passes look for a decline in quality of care... medical school is very different than the NP program... they are very by the book in treatment and aren't trained to look at the larger picture. Example is the quick care clinics. These clinics are notorious for overlooking underlying problematic issues. It's not serving the patient well. These are a few of the issues that states face with these laws.

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Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

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In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

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This is definitely a Beaver production.

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There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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