Health

12 HE ALTH • Spring 2020 • By Livia Gershon Catherine McKinnon, a nurse practitioner at UMass Memorial Medical Center in Worcester, has been among the leading advocates for a new Massachusetts law to allow nurse practitioners to see patients with full practice authority, similar to 22 other states. A t UMass Memorial Medical Center in Worcester, Catherine McKinnon works in pulmonary and critical care, diagnosing patients with complex needs, determining appropriate treatments and prescribing medicines. At HealthAlliance Hospital in Leominster, Duncan Daviau works for Wachusett Emergency Physicians, diagnosing and treating patients who come through the emergency department doors for all kinds of reasons. Neither of them is a physician. McKinnon is a nurse practitioner. Daviau is a physician assistant. Both spent years training to perform many of the same jobs doctors do. As demands on the healthcare system in Massachusetts rise and physician shortages become a more pressing problem, the state projects rapid growth in demand for health professionals like them. But, to fully reach their potential, organizations representing these kinds of workers say, the state must change its laws. Stephanie Ahmed, a nurse practitioner and legislative director of the Massachusetts Coalition of Nurse Practitioners, said many people wait 100 days or more for a first visit with a family physician or pediatrician. The issue is particularly serious in many parts of Central and Western Massachusetts. Ahmed said nurse practitioners are hampered in their ability to help address this situation because the state requires them to have an official relationship with an overseeing physician. "When you think about Massachusetts leading the country in health reform, you need to think about patient visits or prescription writing. In her case at UMass, she said, a doctor simply looks over a record of her prescription-writing and signs off on it. "I have my own malpractice insurance," she said. "I am responsible for the care that I provide, for the medications I prescribe." The problem, McKinnon said, is the law can limit the care nurse practitioners provide depending on choices their physician colleagues make. That's a particular issue when it comes to medication-assisted treatment (MAT) for people with substance use disorders, which health professionals see as a key part of fighting the opioid epidemic. Nurse practitioners need 24 hours of intensive training to receive state waivers allowing them to provide MAT, but even after they need approval from their supervising professional group for physicians, opposes the legal change, saying doctors are subject to different educational and licensing requirements than other providers. "The MMS believes that the physician-led, team-based care model promotes integrated, coordinated care that utilizes all appropriate healthcare professionals while ensuring that physicians are available for consultation or collaboration when necessary to promote the highest quality and safety of care for patients," the organization said in legislative testimony in September. Pushing for autonomy McKinnon, who serves as legislative co-chair of the MCNP, said it's important to note, under current law, physicians don't have to provide day-to- day oversight of nurse practitioners' that in parallel – that we have the most restrictive nurse practitioner act in the country," Ahmed said. "So that really hampers the utilization of this workforce." MCNP is pushing for legislation known as NP SAVE, which would grant nurse practitioners the same full practice authority they now have in 22 states, including the rest of New England, and Washington, D.C. The bill's Senate sponsor, Sen. Marc Pacheco (D-Taunton), said the legal change would make it easier for state residents to get needed care while helping keep healthcare costs down. "Removing outdated and restrictive provisions that are there right now in terms of rules supervising what's going on with nurse practitioners just is long overdue," Pacheco said. However, the Massachusetts Medical Society, the state's main Nurse practitioners and physician assistants are pushing for more autonomy to serve growing healthcare needs Filling the gaps PHOTO/KIMBERLY OLIVER

• Cover