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.

Signed,

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