A Scope of Practice Op-ed: When it comes to medical care, there is no compromising safety
Would you be okay with someone who did not attend medical school performing surgery on you?
Mississippi’s House of Representatives has advanced numerous bills and the State Senate is considering bills that empower non-physician health care providers to perform an increasing number of medical tasks. Whether expanding non-supervised work by nurse practitioners or giving optometrists who did not go to medical school more leeway to perform eye surgeries, these bills all make false promises and put Mississippians’ safety at risk. As physicians, we urge our state legislators to vote down these bills and preserve team-based approaches to Mississippians’ health care.
While there is certainly room for improvement in our current health care system, allowing non-physicians to provide physician-level care is an ineffective fix to a much larger problem. For starters, empowering non-physician health care providers does not translate to increased access to care as some proponents have suggested. In states where nurse practitioners work independently from physicians (most of which occurred at a rapid approval pace over the last few years, like dominoes falling), it has not guaranteed increased service in rural and underserved areas.
The state of Oregon provides the perfect example. While the total number of nurse practitioners in Oregon increased after gaining independent practice, there was no noticeable increase of nurse practitioners within rural, underserved areas.
In our own state, all signs point to a continued shortage even if the law were changed. Just look at the numbers: despite ranking within the top 20 counties by population size, Warren County is home to only 27 certified nurse practitioners. What we need is a solution that expands access to high-quality care, and changes to scope of practice will not accomplish this.
Luckily, there are more promising avenues to address the primary care shortages in our state. For example, the Mississippi Rural Physicians Scholarship Program is a pipeline program that begins in the sophomore year of college and ends with new physicians out in practice nine years later. According to the MRPSP Executive Director Wahnee Sherman, by 2030 this program alone will have placed well over 200 new primary care physicians into the most critical need areas.
We also know that when physicians are at the helm of health care teams, it helps keep the cost of care from ballooning. Studies from the Mayo Clinic and JAMA found nurse practitioners and physician assistants were more likely to make unnecessary referrals and imaging orders, resulting in higher costs.
This has proven true in Mississippi. The Hattiesburg Clinic tried to address primary care shortages by hiring more nurse practitioners and physician assistants. After 15 years of this strategy, they conducted an internal review to evaluate quality of care, costs, and patient satisfaction. Ten years of data collection of over 300 physicians, 150 advanced practice providers, and 208,000 patient surveys revealed alarming results. On nine out of ten key metrics, from simple processes like flu vaccination to more complex cancer screenings, physicians scored higher than advanced practice providers on quality of care. And while seeing less complex patients, care provided by advanced practice providers resulted in significantly higher costs and a higher likelihood of patients going to the ER than those who had a primary care physician.
In states where optometrists have gained surgical privileges despite not attending medical school like ophthalmologists, we have heard similar complaints: uncertainty around correct diagnoses, improperly treating patients, mismanagement of treatment complications, and lack of familiarity around all potential treatment options. It is both dangerous and inefficient, landing patients in the office of an ophthalmologist to fix worsened problems.
State legislators must take this into account when they vote. And if state legislators miss the mark on this scope of practice legislation, Governor Reeves must act as the backstop for quality care and veto any bill expanding non-physician provider abilities.
Rather than setting Mississippi patients on a potentially harmful path by expanding non-physician health care provider abilities, our state legislators should maintain team-based approaches to health care. Only trained physicians should lead primary care teams and perform surgery. Easing restrictions on provider abilities is simply lowering the bar and deepening inequities in Mississippians’ care – a dangerous cop-out to addressing larger health care woes.
W. Mark Horne, MD, President, Mississippi State Medical Association
Claude Brunson, MD, Executive Director, Mississippi State Medical Association
Jennifer Bryan, MD, Chair, Mississippi State Medical Association Board of Trustees
Addressing the Provider Shortage with More Physicians:
A Letter from the Mississippi Rural Physicians Scholarship Program Alumni
To: Members of the Mississippi House of Representatives
We are a group of primary care physicians from across Mississippi and proud members of the Mississippi Rural Physicians Scholarship Program, and we urge you to vote NO on House Bill 1303.
As rural primary care physicians, we know and understand the importance of the team approach to health care, and we believe that nurse practitioners are a vital part of that team. And yes, Mississippi does have a need for more health care providers. BUT, allowing nurse practitioners to practice independently of a collaboration with a physician is not the proper way to address that need.
Physicians train for a minimum of 3 years after medical school, and primary care physicians have 12,000-16,000 hours of direct patient care during that training. Allowing nurse practitioners to practice independently with only a fraction of the amount of education, training, and direct patient care is bad for patient outcomes and bad for the state of Mississippi. Patients, especially those in rural areas, deserve the best care possible, which is with a team of health care providers, led by a trained, licensed physician.
Yes, there is a definite need for more primary care providers in the state of Mississippi. That is an indisputable fact. But, the legislature has already created a program to address that shortage, a program that is in large part why we are able to write you as physicians today – the Mississippi Rural Physicians Scholarship Program (MRPSP). The MRPSP was founded by the legislature in 2007 and tasked with the mission of producing more primary care physicians to address the growing need for providers in our state. The MRPSP currently has 44 physicians in practice across the state, and by this summer, we and our fellow rural scholars will have contributed a combined 162 years of service in rural Mississippi. The program is projected to have approximately 223 primary care physicians in practice in rural areas throughout our state by 2030. The best way to address the provider shortage in Mississippi is to continue to support this program and help it to grow so that we can bring even more physicians to underserved areas of Mississippi.
Kristie Alvarez, M.D. – Batesville
Leah Anderson, M.D. – Waynesboro
Marlaina Berch, M.D. – Corinth
Moumita Biswas, D.O. – Yazoo City
Marketta Blue, M.D. – Mound Bayou
Cameron Bonds, M.D. – Iuka
Cherita Brown, M.D. – West Point
John Browning, M.D. – Booneville
Jonathan Buchanan, M.D. – Carthage
Nikki Cager, M.D. - Clarksdale
Cody Choate, D.O. – Columbia
Cory Coleman, M.D. – Forest
Kendrick Currie, M.D. – Ellisville
Will Davis, M.D. – Corinth
Chad Dowell, D.O. – Indianola
Kelsey Dowell, D.O. – Indianola
Dustin Gentry, M.D. – Louisville
Don Gibson, Jr., M.D. – Forest
Amber Googe, M.D. – Grenada
Stephanie Harrell, M.D. – McComb
Carolita Heritage, M.D. – Brookhaven
Emily Landrum, M.D. – Starkville
Laura Miller, M.D. – Prentiss
John Russell McPherson, M.D. – Amory
Edmund “Ned” Miller, D.O. – West Point
Craig Moffett, D.O. – Maben
Stephen Morgan, M.D. – Houston
Angela Payne, M.D. – Starkville
Anna Marie Hailey Sharp, M.D. – DeKalb
Justin Smith, M.D. – New Albany
Jennie Stanford, M.D. – Laurel
Diana Tate, M.D. – Magee
Renee Taylor, M.D. – Water Valley
Hailey Thompson, D.O. – Philadelphia
Susan Williams, M.D. – Purvis
Brett Zepponi, D.O. - Greenville