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Projected doctor shortage fuels discussion of changing MI health care roles

Advanced Practice Registered Nurses Staci Boyke and Michelle Whalen in the neo-natal intensive care unit at Sparrow Hospital.
Mark Bashore/ WKAR
Advanced Practice Registered Nurses Staci Boyke and Michelle Whalen in the neo-natal intensive care unit at Sparrow Hospital.

By Mark Bashore, WKAR



With Michigan facing a projected shortage of doctors and nurses, a movement is gaining steam to make better use of certain health professionals. State legislators have been working on bills that would expand the responsibilities of some mid-level nurses and physicians' assistants. And last week, Governor Rick Snyder called for a review of the state public health code, in part to officially enhance the roles of what he calls "physician extenders." WKAR's Mark Bashore takes a look.

You might argue that the state's public health code could stand to go on a diet. Michigan's top public health official, Olga Dazzo, describes the tome.

"If I were to print it, it would be very weighty and very large," she says. "I have not dared (print) it because I want to be in a cost-saving mode."

In his official message on health last week, Governor Snyder pointed out how much the health landscape has changed since this opus was last reviewed, then revised, back in the 70's. He and others argue that an update could help Michigan address a myriad of newer challenges like access to care in rural areas and diabetes. It could clarify the duties of health providers and enhance the roles of professionals with advanced degrees, as well as add provisions for new technology like computerized health records.

Olivia McLaughlin is the Executive Director of the Michigan Council of Nurse Practitioners. She says her members--all of whom have masters degrees, sometimes PhD's--could offer more relief to underserved areas.

"The concentration of physicians is going to be far less so in rural areas and that sort of thing and that's, you know, just one of many roles that Nurse Practitioners could play," she says.

The situation is confused because the current health code only uses the blanket term "registered nurses." It doesn't clearly account for Nurse Practitioners and other more highly trained APRN's--that's Advanced Practice Registered Nurses--who could provide a greater level of primary care, like prescribing medications.

But the idea is running into some resistance from doctor's groups. Colin Ford of the Michigan State Medical Society says the root causes of care shortages, for one, are complicated. He says they need a more comprehensive solution.

"Does a rural area in Michigan become more attractive to practice?" he asks. "You know you're still talking about high levels of uninsured patients generally, typically there's not a lot of infrastructure there, lot of long hours, not necessarily the quality of life that folks are looking for. That is not going to change."

Ford says the current health code is flexible enough that it already gives mid-level professionals a relatively wide "scope of practice," meaning the very kinds of responsibilities many nurses want more of. While he expresses great respect for the state's nursing corps, he worries that added responsibilities may exceed their training.

Robert Ortwein has spent four decades in community and public health. As a mental health practitioner, he provided key input in the 1978 health code revision. He says an expansion of nurse responsibilities would be a good thing, but that the right balance with the primary care physician is essential.

"I don't think it's healthy for us to have access to care on such a fast-forward momentum that we forget that we need to have one person looking over the entire care of an individual," he says.

He says the three-year code revision of the 70's worked because the process involved practitioners, like him, and non-governmental entities like the University of Michigan School of Public Health to make such critical distinctions. He suggests the committee that will plot the way ahead adopt a similar approach. The implications for the state's 10-million residents are arguably huge along several fronts. In his address, Snyder called the state's health "the foundation of our economic transformation."

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