July 21, 2008
Nurse Pracatitioners Helping Fill Primary Care Void in State
By Lofton, Lynn
Nurse practitioners are stepping in to help meet primary healthcare needs in Mississippi, and their number is growing. They are especially helpful in medically underserved rural areas. State law requires nurse practitioners to work under the supervision of a licensed physician, but they do not have to be on site with the physician. Under this supervision, nurse practitioners can diagnose and treat routine, common and self-limiting illnesses. They can also follow up and manage previous and chronic illnesses.A recently released health policy brief by Jeralynn S. Cossman, Ph.D., details a survey taken among licensed physicians about their opinions of the role of nurse practitioners. More than 1,400 doctors responded to the survey that was sponsored by the Mississippi State Medical Association, the Mississippi Academy of Family Physicians, the American Academy of Family Physicians and the Social Science Research Center at Mississippi State University.
Pros and cons
The study found that 80% of respondents agree that nurse practitioners are practical physician extenders when supervised. Fewer than one in six respondents favor independent practice for nurse practitioners. Negative responses included the possibility of competition with physicians, an increased risk of liability and lower quality of care.
In light of the physician shortage in the state, Steven C. Brandon, M.D., and president of the Mississippi Academy of Family Physicians, says he hears from many physicians who agree they are at least fully loaded with patients and are seeing more than they might prefer some of the time.
"I think Dr. Cossman's data supports my experience that nurse practitioners can function as an effective assistant to a physician in his/her practice of medicine," he said. "She clearly iterates the requirement that nurse practitioners work under a collaborating licensed physician, one who ideally assists and guides the nurse practitioner by one-on-one consultation and collaboration in the care of their patients."
Brandon said the academy feels this doctor/nurse practitioner association is vital to providing appropriate and quality care to Mississippians when provided by a nurse practitioner.
Tim Alford, M.D., has a family medicine practice in Kosciusko that includes eight board-certified physicians and three nurse practitioners. The first nurse practitioner was brought on board 10 years ago and the third has recently joined the staff.
"My perception is that the state is in dire need - not just rural areas - and these professionals add to the healthcare workforce, provided they have supervision," he said, "but I do have reservations with them being out on the front line."
Pointing out the need for more healthcare providers in Mississippi, Alford says the world of physician training has been slow to wake up to the needs of primary care. "The nurses have stepped up to fill it, but we still need more trained primary care physicians," he said.
The demographics of Alford's area point out the need for more healthcare professionals. Kosciusko has a population of 8,000 and surrounding Attala County has 22,000; yet there are 50,000 active medical charts on file with 13 providers in the area.
"We are still way out of the norm for the ratio of patients per provider," he said. "There is no unifying force planning health needs in the state and there should be. However, I believe those talks have begun."
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.
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."
Debbie Zachary has worked as a nurse practitioner with Lampton for 10 years and had years of nursing experience prior to receiving the additional training. She works at Lampton's Osyka Clinic, which is approximately 10 miles from Magnolia, near the Louisiana state line.
"I have been accepted by the community and my practitioner," she said. "He's very supportive and he knows I would never abuse my responsibilities."
Lampton and Zachary talk and confer frequently about patients. Zachary sees approximately 20 patients a day with roughly half of those having hypertension and diabetes. Others come in for colds, cuts, medication re-fills and school physicals.
"We see patients from age two to death, by choice," she said. "There is no typical day and no day is ever boring."
Zachary does not recommend that nurses go directly from nursing school into nurse practitioner training. "They need maturity and experience in nursing to go into this," she said. "Of course they should love helping people, too. I love it and the patients have become like family."
She thinks state law could be improved by expanding the range of miles allowed between the nurse practitioner and collaborating physician, but otherwise she's content with the existing regulations.
Lampton agrees. "They are fulfilling a significant need and increase access to good healthcare, and I value them," he said. "However, we don't need them in critical care or in emergency rooms. I think the current relationship is the best one."
Copyright Mississippi Business Journal Jun 23, 2008
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