Dr. Randy Easterling, president of the Miss. Medical Assoc., said Wednesday that it may take three or four months, but that the relationships between doctors and the nurse practitioners is the focus.
"There's no effort on behalf of the board, and there's been some innuendo that our new regs are gonna tighten the regulations on nurse practitioners-we don't regulate practitioners. We regulate physicians," he said. "We have a statutory responsibility to protect the public. These new rules and regs are an update, trying to modernize the rules we have pertaining to physicians and their relationship with mid-level providers."
He said the new rules define the "collaborative relationship" between doctors and practitioners. Mississippi is one of some 30 states where the practitioners must be under the oversight of a doctor.
Easterling's Wednesday interview
Talk of the new rules may have been spurred by some cases of prescription fraud and a case at the Sonny Montgomery V.A. where one doctor was supervising 18 nurse practitioners.
Easterling did not specify what rule changes there may be Wednesday, but last week it was suggested that the number of practioners to doctors may be limited to four. There was also a suggestion that the nurse practitioner and doctor's practices could not be more than 40 miles apart.
Some objected to that because of a lack of doctors in some areas.
Jerry and Joanna Lousteau pioneered what has since become a standard practice. Their former Canton clinic employed Joanna, a family nurse practitioner, as the primary caregiver. Though she was still under a doctor's oversight, she said she practiced evidence-based medicine in an area where medical care was needed and there were not enough doctors.
"Nursing is a science and we look at the spiritual, emotional needs, as well as the medical needs of the body," she said.
Joanna described her practice as based on a wellness model versus a medical model, though healing is the primary goal.
"People are more than just chemical beings. I've prayed with patients, I've cried with patients, I've held their hand."
She said one advantage with her former practice is that she had more time to spend with patients to promote wellness by going through their medications and getting them off the unnecessary ones. The Lousteau's clinic was eventually bought out and Joanna went to work for a bigger hospital.
Jerry and Joanna Lousteau
Jerry said he resents the implication on the part of some that quality is an issue with practitioners in the Magnolia State.
"This whole discussion seems to come with public statements from the Board of Medicine that "we're only doing this to look out for the quality of care". Who wouldn't want quality care?" he said. "But there's an unsaid implication that somehow nurse practitioners either don't provide quality care or can't do it unless they are more heavily regulated and that's not the case. Quality care comes from the provider being a good provider and that applies to whether you're a physician or a nurse practitioner."
Easterling wasn't generous with specifics on where he personally believes mid-level providers should stand, but did acknowledge their current status in the overall medical scheme in Mississippi.
"Mid-level providers, which are nurse practitioners and physician assistants, are invaluable in this state and around the country and they provide a much needed service and we want to continue to work with them to make sure that the health care needs of Mississippians are met."
He said his board and the state nursing board are collaborating on the tweaked regs.
Jerry and Joanna Lousteau suggested that tightening the regs to the point that some may like may not be the answer. But, rather meeting somewhere in between to ensure that there's good care and good oversight.