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.”
