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.

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