A bipartisan bill, HB 4399, would change state law to allow nurse practitioners to provide many kinds of medical services without having a contract with a supervising physician.
The Michigan State Medical Society said the current system involves physician-led, collaborative care teams and is best for patient care.
But the Michigan Council of Nurse Practitioners said in reality, many nurse practitioners are already practicing independently, and the supervision from their contracting physicians is in name only. And in some cases, the Council said, the contracts are financially predatory, costing NPs thousands of dollars a month.
The Council said Michigan's restricted practice system is causing nurse practitioners to leave for full practice authority states — contributing to the shortage of primary care practitioners in Michigan.
"The supervision that the contracting physicians provide doesn't even have to be in the same building, county, or geographical area as the nurse practitioner in order to contract with them," said Naila Russell, a family nurse practitioner and legislative committee chair for the Michigan Council of Nurse Practitioners. "So it's a little bit rich to say that, you know, the system will collapse if this goes away."
Russell said she has worked in several full practice authority states before coming to Michigan, and the system worked very well, for patients, nurse practitioners, and physicians.
Testimony before the Michigan House Committee on Health Policy was eye-opening, Russell said. She said nurse practitioners testified they had to suddenly shut down their practices when their supervising physicians retired or died.
That left their patients without care, and left them without a livelihood, scrambling for someone to take their former contractor's place.
Dr. Tom George is CEO of the Michigan State Medical Society. He called the testimony anecdotal, and said that's not a sufficient reason to change a system that is working well.
"Nurse practitioners do a great job helping us reach more patients and in delivering care," George said, "but this bill proposes to change the law so that they would no longer need physician oversight, and we oppose that. We think that this is a public safety issue. We appreciate their skills and service, but we just think it's in the public interest to always have physician backup."
George agreed it may be a problem if some doctors are charging high fees to multiple nurse practitioners in order to pad their incomes, but said that could be addressed without systemically changing the public health code, as HB 4399 does.
A third hearing on the bill before the House Committee on Health Policy is scheduled for Wednesday, May 14th.
