New program would alleviate future issues

By CLAY CHANDLER / Mississippi Business Journal

JACKSON – While the relationship between nurse practitioners and physician assistants has historically been competitive, there is a chance things could soften, with the executive director of the Mississippi Nurses Association having recently taken a spot on the advisory board of Mississippi College’s new physician assistants program.
“Maybe we’ll reach that point one day with physicians,” said Ricki Garrett, MNA chief.
Nurse practitioners perform a lot of the same duties as doctors. They can examine patients, diagnose illnesses and prescribe medications, even those considered controlled substances.
State law, however, requires their work to have the signature of a practicing doctor, or what’s called a collaborating physician. That doesn’t mean the physician has to be in the building. The doctor has to simply sign off on whatever medical procedure the nurse practitioner deems appropriate for a patient.
“I think the vast majority of physicians in the state like working with nurse practitioners and appreciate what they do, but there are those that see those providers as competition,” Garrett said. “I have a hard time understanding that since there is so much need for health care in our state. Obviously, it does come down to money for some people. Most things in life do come down to money.”
Currently, there is no limit on the number of nurse practitioners a single collaborating physician can supervise.
In a move Garrett believes would unfairly restrict the practice of nurse practitioners, the Mississippi State Board of Medical Licensure is considering imposing a limit.
“We don’t need to be limiting (nurse practitioners’) scope of practice. We need to be expanding it. I think it honestly goes back to competition. I’m hoping they won’t do that, but that’s the indication I’m getting,” Garrett said.
Dr. Vann Craig, executive director of the Medical Licensure Board, said the board is considering limiting the number of nurse practitioners who can work under one physician, and he said it has nothing to do with competition.
“The concept of capping the number of nurse practitioners that a physician may supervise or collaborate with is not unique to Mississippi. Multiple states do this. This isn’t something brand new. Ms. Garrett needs to be aware of that.
“Let me put it this way. If you have 20 people working under you, are you making sure they’re doing their job property? Probably not, particularly if you have an active job that you’re doing yourself. Physicians are in active practice. The problem is the level of supervision that is provided for an intermediate-level practitioner. That’s the reason for (considering) restriction,” Craig said.
The Licensure Board’s next meeting is scheduled for Nov. 18 in Jackson office.
Whatever the reason for the board considering a limit, Garrett said it would especially hurt the rural areas of Mississippi that have been medically underserved for decades. Often, she said, rural counties have only one doctor, so if there is a restriction on the number of nurse practitioners who can work under that doctor, the options for primary care are limited.
There is another option Garrett and the MNA can pursue.
Mississippi is one of 36 states that require nurse practitioners to work directly under a physician. Fourteen states allow for the unattachment of nurse practitioners and physicians. While nothing is certain, Garrett did say the MNA is considering lobbying the Legislature during the 2011 session to pass a measure that would, in effect, remove the supervisory role doctors currently play.
“Of course, nurse practitioners will always collaborate with other physicians,” Garrett said. “They just wouldn’t have to have the signature of a physician. We’re certainly looking at that now, primarily because of the continuing efforts to try to restrict their practice (by the Board of Medical Licensure).”
Said Craig: “Our purpose in life is the protection of the public, If people are not being properly supervised, looked at or collaborated with, whatever term you wish to use, the public is not being protected. That is our issue, and should be the Nurses Association and Board of Nurses’ desire.”