As the nation continues to battle a physician shortage, Mississippi lawmakers are looking to create more healthcare options in one of the poorest and sickest states.
Legislation passed in the House of Representatives that would allow advanced practice registered nurses (APRNs) to operate independently and create a new category of licensed anesthesiologist assistants. HB 849, which was met with bipartisan support and dissent, creates an avenue for APRNs including nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, to act inside the boundaries of their expertise without first consulting a doctor.
Recent estimates found that Mississippi has 5,857 active physicians and nearly 9,000 APRNs. According to research from the American Medical Association, 83 million Americans live in areas that don’t have sufficient access to a primary care physician. Those issues are further exacerbated in a rural state like Mississippi where a bulk of the state’s women have grave difficulty finding an obstetrician during pregnancy.
In an attempt to further access to care, Republican Rep. Sam Creekmore, who oversees the House’s Public Health and Human Services committee, authored the bill to allow APRNs to sever a currently mandated collaborative relationship with a physician after completing 8,000 hours on the job.
“Over the years, physicians have led the way in advancing healthcare in Mississippi, improving patient outcomes, and shaping a system that delivers high-quality, evidence-based medicine,” Creekmore said. “However, as patient demand continues to rise, particularly in primary care, anesthesia, and chronic disease management, the healthcare model must evolve to ensure Mississippians receive timely and effective care.”
The lack of physicians to meet the needs of rural and underserved communities is especially burdensome in the Magnolia State with some doctors having to routinely bounce from one hospital to another to tend to patients. Rural physician scholarships are available for medical students attending the University of Mississippi Medical Center and William Carey University College of Osteopathic Medicine to add to the future workforce.
Nonetheless, quality healthcare providers are needed now, and Creekmore contends that long-tenured APRNs are perfectly capable of treating patients without physician oversight. These nurse specialists would also have assistance. HB 849 launches an anesthesiologist assistant program, with qualified participants being licensed by the Mississippi State Board of Medicine.
“Current over-regulated barriers placed on [nurse practitioners] create unnecessary access to care barriers for patients. The number of primary care providers in the state is insufficient to care for the existing patient loads,” a statement from the Mississippi Association of Nurse Practitioners reads. “APRNs can fill this gap that is desperately needed to care for the residents of Mississippi.”
Creekmore added that APRNs acting independently could have to pay more for their malpractice insurance and would be liable for any botched medical procedures just as a physician would. A physician would not be responsible for any error by a nurse acting without a collaborative agreement.
Despite proponents touting how the bill would be a step in the right direction in solving Mississippi’s dire healthcare needs, the legislation has its detractors.
“Would you trust your life or a loved one’s life in the operating room without a physician supervising anesthesia? A House Bill threatens to remove critical safeguards for patients, elevating the risk when medical emergencies arise,” a commercial paid for by the Mississippi State Medical Association (MSMA) asserts. “When seconds count, only a physician-led team can make the difference between life and death.”
In its January 2022 journal, the MSMA penned an editorial from Hattiesburg Clinic titled “Targeting Value-Based Care with Physician-Led Teams.” In the article, a trio of doctors explained how Hattiesburg Clinic welcomed an influx of non-physician specialists and allowed them to take care of patients independently, with a supervising physician available.
What was discovered, per the editorial, was that healthcare provided by non-physician specialists was more expensive and less efficient than care rendered by a licensed doctor. That conclusion was drawn after a decade of examination, according to the piece.
At the administrative level, State Health Officer Dr. Dan Edney is in favor of physicians and APRNs collaborating as a team to tackle ongoing healthcare woes in Mississippi. He is also an advocate for professionals having the ability to operate at maximum capacity.
However, he raised concerns about the prospects of curriculum changes in healthcare education to add to the workforce of a fragile industry. Edney fervently stands against virtual learning as a substitute for in-person training to speedrun courses and argues that caution needs to be exercised if APRNs are going to have their training wheels removed.
“I believe in any professional being able to practice their profession at the full extent of their training and experience — and that comes through licensure,” Edney said. “I am concerned that we don’t need to be ‘dumbing down’ medical or nursing education by virtual training. It’s not the same. We don’t allow doctors to do medical school virtually. I don’t believe that mid-levels should be doing a lot of virtual training. It needs to be what has historically proven to work.”
HB 849 passed on a 77-33 vote, but not without alteration. An amendment offered by Democratic Rep. Bryant Clark to up the number of medical students receiving a rural physician scholarship from 62 to 100 was adopted. The legislation now sits in the Senate’s Public Health and Welfare committee, where it must be cleared before heading to the floor for a full vote.
