Nurse Practitioners

Gov. Martin O'Malley signed legislation Tuesday to allow Maryland's nurse practitioners to cut bureaucratic delays and start practicing more quickly, a move providers hope will help alleviate the state's primary-care doctor shortage. The law streamlines the bulky credentialing process required for nurse practitioners to treat patients in Maryland. A process that now requires approvals by separate boards of doctors and nurses –- and can take up to six months — will be shortened to about a month, cutting the standard 19-page working agreement between nurses and doctors to a single page.

Letter writer Ted Houk resorts to specious statements to argue that patients should verify the credentials of their caregivers to make sure they are being treated by licensed physicians rather than by people who merely claim to be doctors ("Beware of charlatans claiming to be physicians," Dec. 13). He uses as an example Shawn Nowlen, the Baltimore city schools employee who marketed himself to parents as a social worker and a counselor when in fact he was neither, and who impregnated at 15-year-old girl whose mother entrusted her to his care.

Faced with a chronic shortage of family doctors, whom will Americans call in the next few years if they develop an ulcer, get an infection or come down with the flu? If Janet Selway gets her way, they'll have the choice of calling their family nurse.In her Cockeysville office, Ms. Selway sees patients with strains and sprains, conducts physical exams, orders lab work and X-rays, diagnoses common health problems, writes prescriptions -- most of the routine things that a general practice physician might do in the course of a hectic day.But she isn't a doctor.

Everyone is a doctor until proven otherwise. I can show you my current medical license, but Shawn Nowlin couldn't have shown you anything ("Schools employee charged with sex with teen," Nov. 29). It is horrific that he allegedly got a 15-year-old girl pregnant. People bet their life that the person in front of them claiming to be a doctor can help. Chiropractors, acupuncturists and naturopaths, physician's assistants and nurse practitioners are not physicians and they should not call themselves "doctor" or let people call them that.

Like so many primary-care providers strapped for time, Tricia Angulo-Bartlett crams as much as she can into a 15-minute patient visit. At one last week, she counseled Amy Tucker about her coming surgery, evaluated her chronic sinusitis and scribbled a few prescriptions, taking time to explain the side effects and directions of each one. Along the way, she managed to ask about Tucker's twin boys. Then Angulo-Bartlett was off to dictate her notes and on to the next patient. She'll see 26 in a typical day. Such is the life of a busy nurse practitioner, a group of providers that is increasingly helping deliver primary care amid a national shortage of family doctors.

Gov. Parris N. Glendening reversed a hard-won victory for the nursing profession yesterday as he vetoed legislation that would have let nurse practitioners serve as primary care providers for patients in HMOs. The veto, which disappointed some of the governor's staunchest supporters, was one of 18 announced yesterday. The vetoed bills included, as expected, one that would have required gun safety education classes in public schools. Also vetoed were bills that would have given a tax break to cigarette wholesalers and repealed the 50-mph speed limit for school buses.

Reimbursement cuts add to strain on doctors I appreciate Dr. Peter Beilenson's generally sympathetic column regarding the plight of primary care medicine in Maryland ("A growing medical menace," Commentary, Dec. 5). But with all due respect, does anyone actually believe that Medicare and private insurance companies will increase their reimbursement rates for any physicians in the coming year? Most of my medical colleagues are expecting rate cuts of 10 percent to 20 percent in 2009, which will make maintaining a medical practice virtually impossible for many of us. Boutique medicine is not for everyone.

NURSE PRACTITIONERS in Maryland won a victory recently when the General Assembly passed legislation giving HMOs the option of allowing enrollees to choose either a physician or a nurse practitioner as their primary care provider. The average person seeking quality health care now has greater choice and ultimately more control over where he or she decides to go for care. For nurse practitioners, however, the legislative battle was not easy one, but definitely worth the fight. Gov. Parris N. Glendening still must sign the legislation.

Nurse practitioners who educated legislators, negotiated with MedChi and reached out to all stakeholders were happy with the outcome of legislation to reduce the administrative burden of a physician collaborative agreement. The lengthy form and approval process was eliminated and will be replaced with a written statement by each nurse practitioner on file at the Board of Nursing. This highlights two things. First, public acceptance of the high quality, safe and cost effective care by nurse practitioners.

After three years of fierce lobbying, the General Assembly is ready today to settle a turf battle between doctors and nurses that goes to the core of who they are and what they do. The state's 1,600 nurse practitioners, casting themselves as scrappy underdogs against Maryland's leading physicians' group, have fought for legislation allowing patients in HMOs the option of selecting practitioners as their primary care provider. Maryland's health maintenance organizations allow only doctors to assume that role.

Hospitals and other health care providers in Maryland are receiving a total of $2 million in federal money to reimburse them for investments they made in new electronic record systems, state officials said Thursday. The grants were the first in a series being offered in coming years. They were only available to providers who have a certain number of Medicaid patients and already switched to the new system, said Lt. Gov. Anthony G. Brown. Brown said the technology will ensure providers have the right information about patients and that will improve care, in addition to save money.

State officials on Tuesday announced a plan to increase the number of primary care health professionals by as much as 25 percent in the next decade through a wide range of goals that include increased educational opportunities, financial incentives and tort reform. Maryland and the rest of the country are dealing with a shortage of primary care physicians and fear the problem will worsen when health care reform adds millions more people to the insurance rolls. Nearly 360,000 new people will have access to insurance in Maryland by 2020.

Nurse practitioners who educated legislators, negotiated with MedChi and reached out to all stakeholders were happy with the outcome of legislation to reduce the administrative burden of a physician collaborative agreement. The lengthy form and approval process was eliminated and will be replaced with a written statement by each nurse practitioner on file at the Board of Nursing. This highlights two things. First, public acceptance of the high quality, safe and cost effective care by nurse practitioners.

Shame on the legislature for buckling under to MedChi ("New Md. law smoothes the way for nurse practitioners," April 14). Patient care is not the physicians' concern in pushing for the state to maintain the requirement that nurse practitioners not be allowed to practice independently from doctors; it is the 30 percent of the nurse practitioner's profit they take to sign a piece of paper and hope no one bothers them afterwards. Even in health centers where the doctor is in the same set offices, the nurse practitioner is the primary care provider.

Gov. Martin O'Malley signed legislation Tuesday to allow Maryland's nurse practitioners to cut bureaucratic delays and start practicing more quickly, a move providers hope will help alleviate the state's primary-care doctor shortage. The law streamlines the bulky credentialing process required for nurse practitioners to treat patients in Maryland. A process that now requires approvals by separate boards of doctors and nurses –- and can take up to six months — will be shortened to about a month, cutting the standard 19-page working agreement between nurses and doctors to a single page.

H1N1 flu shots for babies and toddlers A walk-in clinic for babies and toddlers ages 6 months to 35 months old sponsored by the Anne Arundel County Department of Health will be held 10 a.m. to 2 p.m. Tuesday in the lower-level conference room of the Health Services Building, 3 Harry S. Truman Parkway, Annapolis. No other age group will be vaccinated at the clinic. For flu prevention and vaccine information, go to aahealth.org or call the H1N1 Flu Immunizations Line at 410-222-4896.

Letter writer Ted Houk resorts to specious statements to argue that patients should verify the credentials of their caregivers to make sure they are being treated by licensed physicians rather than by people who merely claim to be doctors ("Beware of charlatans claiming to be physicians," Dec. 13). He uses as an example Shawn Nowlen, the Baltimore city schools employee who marketed himself to parents as a social worker and a counselor when in fact he was neither, and who impregnated at 15-year-old girl whose mother entrusted her to his care.

THE United States has a shortage of primary-care physicians.This limits the options for improving access to cost-effective health care.Nurses are a national resource with the potential to meet this challenge.Since the late 1960s, federal policy has promoted two strategies increase primary care. The first included federal support for establishing a new physician specialty in family practice.It has not yet been successful. Between 1970 and 1990, the proportion of doctors in primary-care actually declined and the rate of decline is accelerating.

Team approach best for primary care The article "Nurse practitioners pick up the slack in providing primary care" (Aug. 9) makes an important point about building our primary care workforce. However, it should be expanded to mention the importance of team care in providing high quality primary care. Nurse practitioners and physicians ideally function in a close professional relationship, communicating frequently such that each can bring his or her own insights to a clinical issue. Nurses, physician assistants, administrative staff and other health professionals are often members individually or in various combinations of a primary care team.

Like so many primary-care providers strapped for time, Tricia Angulo-Bartlett crams as much as she can into a 15-minute patient visit. At one last week, she counseled Amy Tucker about her coming surgery, evaluated her chronic sinusitis and scribbled a few prescriptions, taking time to explain the side effects and directions of each one. Along the way, she managed to ask about Tucker's twin boys. Then Angulo-Bartlett was off to dictate her notes and on to the next patient. She'll see 26 in a typical day. Such is the life of a busy nurse practitioner, a group of providers that is increasingly helping deliver primary care amid a national shortage of family doctors.