Tuesday, December 3, 2013

What to do?

I have been MIA on this blog for a while getting through the paperwork of both the state and federal government of my NP license. Now that I am an NP and have furnishing privileges , I wonder. No longer about the journey to get here or that I can write scripts. But what should I do now?  I need a job and to get experience. A minimum of 2-years if I want to practice in one of the independent states.
I see many independent practice state are trying to lure NPs away from restricted states (as in the article below), but the pay rate is about the same. I would love to be independent but the comfort of a doctor's availability and knowledge is invaluable.
I need to stop thinking about what if's and just get a job.

"New Mexico governor wants to recruit Oklahoma's nurse practitioners by Jaclyn Cosgrove

Governor Martinez wants to market New Mexico beyond its ski vacations, hot air balloons, beautiful desert sunsets and art museums.
Simply put, Martinez wants Oklahoma's nurse practitioners. Unlike Oklahoma, New Mexico allows nurse practitioners to practice with “full authority,” not requiring them to have a physician sign off on care in order for them to have prescriptive authority. Martinez specifically mentioned Oklahoma in her recent announcement of the campaign, adding that she hopes to further reform her state's laws to remove any barriers that nurse practitioners moving to New Mexico might face when opening their practices. “The full implementation of (New Mexico's Medicaid program), coupled with Medicaid expansion, will further increase the demand for highly trained and qualified health care professionals in New Mexico,” Martinez said in a news release. “By streamlining the requirements for nurses seeking to bring their talents and skills to New Mexico, we can further ensure that more New Mexicans, especially in rural and underserved areas, will have access to the high quality of health care our families and communities deserve.”

Time to move?

Moving to a state like New Mexico was, at least for a moment, in the back of nurse practitioner Damarcus Nelson's mind. Nelson graduated about two years ago and was thinking about where he wanted to practice medicine. But he had family in Oklahoma and a wife, pregnant with twins. Moving wasn't an option at the time. “I feel like if we stay here, we can push the envelope better to get independent practice here, as opposed to trying to run to another state,” Nelson said.
Nelson, who has a doctor of nursing practice degree, works near Yukon with Toni Pratt-Reid, the first nurse practitioner in Oklahoma to open a private practice more than 10 years ago.
Under Oklahoma law, a nurse practitioner cannot practice medicine unless he or she has a physician willing to supervise him or her for that prescriptive authority. However, the law doesn't require physician supervisors to review patient charts or even practice in the same building.
At Pratt-Reid's office, there is not a medical doctor or doctor of osteopathic medicine who works in the office with them. “We wouldn't practice any differently if we had full autonomy,” Pratt-Reid said. “Nothing that we did here would be different, other than we wouldn't have to jump through extra hoops to get the same amount of care ... . The sooner we get to where New Mexico is, the better.”

Many states open to practice

Oklahoma is one of about 12 states that requires a nurse practitioner to have a team leader or management from an outside health discipline — such as supervision from a medical doctor — in order for that nurse practitioner to provide care, according to the American Association of Nurse Practitioners. About 15 states — some that require stringent restrictions and some that simply curtail one element — have bills in 2014 that would reduce restrictions, according to the group.
No bill has been discussed or announced in Oklahoma. New Mexico and Oklahoma face similar problems, with large shortages of medical professionals across both states. Thirty-two of New Mexico's 33 counties are designated by the federal government as Health Profession Shortage Areas, according to the governor's office. Only four of 77 counties in Oklahoma are not designated as Health Profession Shortage Areas, according to the state Health Department.
Rep. Doug Cox, R-Grove, has focused many of his efforts at the Capitol on Oklahoma's doctor shortage. Cox, a medical doctor for more than 30 years, said medical “extenders” — nurse practitioners or physician assistants who extend the care medical doctors provide — are a necessary part of the health care system. Cox is the physician supervisor for a nurse practitioner in Grove, a city of 6,600 in northeast Oklahoma. More than 1,200 doctors in Oklahoma are supervising about 1,000 nurse practitioners, according to data from the state medical board.
Cox said he saw a need for a medical professional to help treat people, and he felt like supervising a nurse practitioner would be a way of doing his part to address the provider shortage in his area.
“The No. 1 reason I see people in the ER is because they can't get into a doctor's office,” Cox said. “There just aren't health care providers to serve the need, but our nurse practitioners have liberal prescribing authority.” Nurse practitioners in Oklahoma are not allowed to prescribe certain drugs, including oxycodone, a strong pain medication, and Adderall, a drug prescribed to children with attention deficit hyperactivity disorder.
Tulsa nurse practitioner Mindy Whitten said such restrictions regularly create a problem at her job.
Whitten works at an urgent care medical office, a setting where health care providers regularly prescribe Schedule II drugs like oxycodone. If a medical doctor isn't at the office when a patient who is allergic to codeine and hydrocodone comes in suffering pain, there aren't many other options for her to prescribe.
“I don't have a pain medicine I can write for them because the next one is oxycodone, and that is a Schedule II drug,” Whitten, the legislative chairwoman of the Oklahoma Nurse Practitioners, said. “I have to tell them, ‘I'm sorry, I can't write a prescription for you. You'll have to go over to the ER.'” Another obstacle that nurse practitioners face is in paying physicians for signing off to supervise them, she said.
For example, some physicians charge nurse practitioners between $2,000 and $3,000 each month, she said. It's a charge they wouldn't have to pay if they lived in states like New Mexico.
“Nurse practitioners are starting their own clinics in rural and underserved communities,” she said. “If I'm going to pay $24,000 a year, I can live in New Mexico and not worry about it and own my own practice.”

Dr. Gabriel Pitman, a trustee on the board of the Oklahoma Osteopathic Association, said if a doctor is playing a role and is available to a nurse practitioner, they deserve compensation for participating in the nurse practitioner's practice. Under Oklahoma law, a physician supervising a physician assistant is required to be on site at the clinic for a certain amount of time each week, whereas with nurse practitioners, a physician isn't required to be at the clinic.
Pitman, an Oklahoma City neurologist, said a physician is necessary to supervise a nurse practitioner or physician assistant because they aren't as rigorously trained as medical doctors and doctors of osteopathic medicine. In Oklahoma, nurse practitioners are required to have a master's degree along with clinical hours. Requirements are expected to change in 2015 to require a doctorate.

The Oklahoma Osteopathic Association supports nurse practitioners and physician assistants in the roles they serve in the health care system — just not without supervision, he said.
“We feel that a physician must always serve as the team leader, as they are the only comprehensively trained health care professional prepared to make a diagnosis and establish a treatment plan,” he said. “We feel direct access to nonphysician health care professionals endangers patients' health. We feel direct access also puts the patient in the unfortunate and confusing position of being forced to choose among the series of health care professionals, not all of whom are adequately trained to make well-informed diagnoses.”


Candi said...

It's very frustrating, especially when I know from physician's own mouths that they lose more than half of that "rigorous" mediclal knowledge that they gained in school once they start practicing. Medicine is like anything else, you lose what you don't use. If you work in a primary care office you have the skills needed to see those types of patients and no more, and that comes from the experience of "doing it" day in and day out, NOT from medical school. I would go so far as to say by 5 years out a practicing NP knows just as much as a PCP if praciting in the same setting. In this case supervision is ridiculous. I wish more states would come on board, but I'm thankful for the ones who already allow independent practice. Good post. Can't wait to hear about your job search.

Candi said...

Stupid typos!!