Breaking up medical teams will not solve physician shortage

As a Mississippi-licensed board-certified family medicine physician, I’m very concerned about House Bill 1303, which would remove the supervision requirement for advanced practice nurses collaborating with physicians.

I have been a Mississippi physician in family and emergency medicine for nearly four decades, and from this experience, I have great confidence in a team approach to healthcare — with that team being led by a physician. A team-based system offers the safest approach to medical care. By focusing on their unique skills, every member of the team plays an important role in providing high-quality patient care.

I was proud to support the University of Southern Mississippi’s initiative to begin a Nurse Practitioner Program in the early 1990s. The idea was to expand the training of nurses to assist physicians in their practices because of the shortage of primary care doctors in rural settings in Mississippi. This was a great solution to improving access to health care for rural Mississippians.

The original plan was for nurse practitioners (NPs) to serve as physician “extenders,” which would allow the physician to take care of additional patients while the NP would handle appropriate complaints, follow up visits, and wellness exams. Under this approach, NPs were to instruct in diabetic management, and other important duties. Since NPs are trained in the nursing model, healthcare instruction and teaching would have been their forte and a huge asset to physician-led care.

However, not long after the population of NPs increased, some hospitals and clinics began using them as “providers,” working in the same capacity as physicians as opposed to being in the “extender” role as originally planned. Soon after, some NPs sought to be referred to as “providers” with the intent to practice medicine without medical school and residency experience.

Taking it a step further, a very vocal few — supported by organizations and resources from outside the state — are pushing to upend the proven, physician-led model of team-based healthcare, and I strongly believe this change will not be in the best interest of public health. The collaboration between physicians and nurse practitioners leads to superior patient outcomes and should be safeguarded. Medical school and residency training matter. Training a nurse and then training as an NP for an additional 18 months, possibly online, does not prepare NPs to handle the wide range of knowledge and experience necessary to practice the full scope of medicine.

Ideally, healthcare should be a team approach, led by the physician. Physicians value NPs as part of the team — they bring incredible skills to patient care. But specialty training and medical school training are essential to provide the best diagnosis and treatment for patients.

Unfortunately, well-intended efforts to provide flexibility to NPs have set in motion a trend of some NPs pursuing practice without supervision. Mississippians want and deserve team-based care. A recent poll showed that more than 90 percent of Mississippians want physicians and nurses to work together. That is a powerful message.

As I mentioned earlier, the mission for training NPs in Mississippi was to better assist physicians in their practice because of the shortage of primary care doctors in our state. We still face a physician shortage, but breaking up high-functioning and effective medical teams is not the way to solve it.

Physician-led collaborative care is the best way to ensure Mississippians receive the health care they need. I am urging Mississippians who are concerned about patient health and the health of our state to contact their state representatives at 601-359-3770 to ask them to VOTE NO on House Bill 1303. I also encourage people to learn more about the importance of keeping medical teams together at www.scopeofpracticems.org.

Dr. J. Lee Valentine is Board Certified in Family Medicine. He was the founding program director for the EC HealthNet Rural Family Medicine Residency Program in Meridian and presently serves as associate program director.

Coast doctor argues against bill that would allow unsupervised nurse practitioners

As a Mississippi-licensed internal medicine physician, I’m very concerned about House Bill 1303, which would remove the supervision requirement for advanced practice nurses collaborating with physicians in our state.

Each member of a medical team brings value to patient care. Each role is important, but physicians bring more than 12,000 hours of training and experience, and that training matters.

The training physicians undergo is extensive. After four years of medical school, I completed a combined medicine/pediatric residency and became board certified in internal medicine. My residency included four years of learning from the more senior residents to the attending physicians on the team. With each year of residency, residents get a progressive experience that gives them hands-on training to master the practice of medicine. First-year residents are down in the trenches learning and being reviewed by second and third-year residents, who oversee and tweak their treatment plans, ensuring these plans are correct. Each year, more and more responsibilities are added to the residents’ duties.

Residents attend rounds daily, where every patient is presented, and attending physicians discuss the treatment plan and the underlying science behind the disease processes as well as the treatments recommended. A physician’s medical knowledge is constantly tested and enhanced through these experiences, daily lectures, and exams. Furthermore, residents are tested throughout medical school and residency through a national standardized testing system that is designed to ensure mastery of medicine—mastery that matters when you are responsible for the health of patients.

Nurse Practitioner (NP) training is extremely important, but it is limited to nursing school and an NP certification that is often completed 100 percent online. There is no admission criteria to many of the NP certification programs other than having a nursing degree. The training is less in-depth, spanning a few months and covering a maximum of 700 hours—some with open-book tests and a certification exam given by the certifying body of their choice. NPs are trained to work alongside physicians to provide patients with the best level of care, but an NP is not a replacement for a physician.

On my medical team, I serve as the lead for an NP, medical assistant, and a licensed practical nurse, who as a team all take care of triage, make initial assessments, check vital signs, and reconcile medications. Without a physician leader for a medical team, the team lacks the expertise and direction grounded in extensive medical training.

A patient once came to my office with a red swollen leg and reported to the NP that he had stepped on a nail. From there, the NP presented the case for an antibiotic. After my own assessment, I discovered he was wearing a shoe at the time of the injury. This was an important question because this makes a difference in the chosen antibiotic to appropriately treat the infection. This was not knowledge the NP possessed. The education physicians have is essential for proper diagnosis and care for patients. Without my knowledge on the subject matter that patient would have been improperly treated.

We cannot permit NPs working outside of the boundaries of their education. It is not safe for patients. NPs are incredible assets to the medical team, but they do not have the medical school training or board certification of a physician. Medical school matters. The medical team matters. Let’s keep medical teams together for the better of health of everyone in Mississippi.

Physician-led collaborative care is the best way to ensure Mississippians receive the health care they need. I am encouraging all Mississippi Gulf Coast residents to contact their state representatives at 601-359-3770 to ask them to VOTE NO on House Bill 1303. Mississippians can also learn more about the importance of keeping medical teams together at www.scopeofpracticems.org.

Dr. Amber Colville, MD, originally from Pascagoula, Miss., has been working in internal medicine, for 20 years. She received her undergraduate degree from the University of Southern Mississippi, studied medicine at Ross University, and completed her internship and residency at the State University of New York Health Science Center of Brooklyn. Dr. Colville currently works at New Wave Internal Medicine in Ocean Springs, Miss., and is Board Certified by the American Board of Internal Medicine.

Reject bill to allow optometrists to perform surgery

The eye is a wonderous and complex organ. The sight that it gives us is to be cherished and protected. Having done surgery as an ophthalmologist for more than 30 years, I know firsthand the challenges of operating on the eye. It is a fine art honed by years of practice based on many years of study. The privilege to do surgery should be based on extensive training and skills that only a full medical school and ophthalmology residency provide.

The intricacies of safe and successful surgery, the ability to handle complex situations, the forethought to anticipate risks to the patient and the patient’s sight cannon be learned without extensive training. The ability to handle complications and salvage sight comes only with extensive practice.

Currently, the Mississippi Legislature is considering House Bill 1302 that would allow optometrists to perform surgical procedures in and around the eye. Optometrists are neither physicians nor surgeons. They have not attended medical school. They have not been trained as surgeons. Allowing optometrists to wield scalpels and lasers to operate on our eyes is simply dangerous and not in the best interest of Mississippians.

Please do not allow this surgical proposal by optometrists to see the light of day. Please protect our citizens from the danger that will certainly occur if you legislate surgical privileges to those who really have no training in being physicians or surgeons. The right to operate on this most delicate and precious organ should be learned, not legislated. It should be earned through medical school and ophthalmology residency training, not paid for by those seeking the privilege of surgery.

Please contact your state representatives and urge them to VOTE NO on House Bill 1302.

Jeffrey N. Cook, M.D.

Meridian