MAFP Priority Issues

Mafp Supports A Physician To Lead The Health Care Team

OPPOSE HB 69 (Dinkins), HB 271 (Riley), HB 284 (Lewis), HB 329 (Cook), HB 330 (Cook), SB 27 (Brown), SB 79 (Schroer), SB 157 (Black)

• MAFP believes the physician-led team approach delivers the best and most cost-effective care to Missourians and that APRNs, PAs, and APs are dedicated, skilled members of the health care team.

• 4 out of 5 patients prefer a physician-led health care team (AMA 2018 Survey)

• A 2022 National Bureau of Economic Research study found that independently practicing NPs within the US Dept. of Veterans Affairs increased the patient’s length of stay, raised the cost of emergency department care, raised the 30-day preventable hospitalizations, decreased opioid prescriptions, and increased antibiotic prescriptions.

• Due to extenuating circumstances, the MAFP would support an arbitration board to mediate requests to create special arrangements within the collaborative practice requirements that would be overseen by the arbitration board.

• A new nurse practitioner received 3-10% (500 – 1,000 hours) of the clinical training of a family physician (15,000 hours.)

(Source: Primary Care Coalition)

• Data from states with independent practice for mid-level providers clearly show that this does not resolve the health care workforce shortage. Mid-level providers practice primarily in the higher population geographic areas with fewer in health professional shortage areas (HPSA). The 2022 Missouri Board of Nursing Workforce reports shows that 5.3% of APRNs practice in a rural area.

• A standardized curriculum from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education ensures all physicians are trained on the best practices, research, and advancements across the continuum of medical education. APRN programs are not required to maintain a standardized curriculum and most content is taught online.

• Considering the physician shortage, geographic APRN location data, and the proliferation of APRN online courses, it is imperative to increase the number of primary care physicians. This will not only meet today’s demand for physicians, but will also ensure there is a qualified workforce in the future for Missourians.

Increase Family Medicine Residency Capacity

• The MAFP supports expanded primary care residency slots to meet the demand for primary care physicians. Missouri has the capacity to add 17 family physician residency slots per year.

• Funding: Regular and dedicated state appropriations are needed to incentivize Missouri medical students to choose primary care residencies. Missouri has 4,555 medical students for 1,257 primary care residency slots (over 3 years). Research shows that resident physicians will set up their clinical practice within 60100 miles of the location where they complete residency.

Safeguard The Physician And Patient Relationship

A patient’s physician has access to the patient’s full history and medical record. A physician is best equipped to assess conditions in the context of the whole patient, recommend, order, and interpret diagnostic tests and imaging studies, and refer to other healthcare professionals as needed. Physicians also have undergone the extensive training required to assess the need for pharmacological treatment and to prescribe medications as may be indicated and appropriate for the patient.

• OPPOSE HB 710 (Buchheit-Courtway), SB 418 (Brown) – A physician and patient relationship is not established through a questionnaire. This is a useful tool in assessing an existing patient and for minor issues. It is important to interview the patient, take a medical history, and perform a physical exam.

• OPPOSE HB 99 (Davidson), HB 115 (Shields), HB 144 (Doll), SB 51 (Eslinger), SB 205 (Moon) –Physical therapists should work with a referring physician to ensure proper diagnosis and treatment of the patient.

• OPPOSE HB 249 (Busick), SB 270 (Roberts) – Dentists focus on oral health and treatment and do not have a patient’s full medical history. Dentists administering vaccines further fragments the patient and physician relationship by adding another provider of care.

• OPPOSE HB 331 (Cook), SB 41 (Thompson Rehder) –The pharmacist and physician work collaboratively so their combined expertise is used to optimize the therapeutic effect of pharmaceutical agents in patient care. When vaccines are administered elsewhere, the information should be transmitted back to the patient’s primary care physician and their state registry to assure continuity of the patient’s medical record. The physician’s knowledge of the patient history could minimize a potential adverse reaction to the vaccine.

• OPPOSE SB 322 (Mosley) – Naturopathic education does not prepare practitioners to properly and accurately diagnose or provide appropriate treatment, safely or effectively prescribe medications, perform physicals, or perform surgical procedures.

• NEUTRAL HB 163 (Seitz), HB 818 (Titus), HB 838 (Lewis), SB 62 (Razer), SB 108 (Arthur), SB 160 (Schroer), SB 356 (Moon), SB 453 (Moon), SB 491 (Cierpiot), SJR 8 (Eigel), SJR 19 (Moon) – Family physicians provide reproductive health and education to their patients as needed. The MAFP supports evidence-based practice of medicine, patient-physician relationship, and the delivery of safe, timely, and comprehensive care. Physicians should not be criminalized for the health care provided to Missourians. We respect each member’s view and ultimately have not taken a position on abortion to reflect the broad span of opinions of family physicians across the state.

Immunizations Protect Our Communities

• MAFP supports immunizations to protect Missouri’s infants, children, adolescents, adults, and seniors.

• The MAFP supports local health agencies to develop public health policies and plans that could mitigate the impact of the epidemic on their communities. We support evidence-based decisions to ensure the safety and health of communities in ordinary times and in a state of emergency.

• OPPOSE HB 445 (Schnelting), SB 159 (Schroer), SB 99 (Eigel), SB 201 (Brattin) SB 232 (Carter) – Immunizations are among the most cost-effective and successful public health interventions. Without vaccines, diseases such as measles and pertussis are becoming more common in the United States.

• We understand recent public apprehension about vaccines due to policies put in place during the pandemic. Routine vaccines prevent and eradicate preventable diseases such as measles, mumps, and polio. These immunizations are a vital component for better public health.

Patients Deserve Access To Quality Health Care

• The MAFP believes that all Missourians should have access to essential health care services, regardless of social, economic, or political status, race, religion, gender, or sexual orientation. We support measures that increase Medicaid coverage to Missourians who lack affordable health care.

• SUPPORT HB 254 (Pollitt), HB 286 (Lewis), HB 328 (Bosley), SB 90 (McCreery) which extends the current coverage of pregnant women receiving MO HealthNet pregnancy-related and postpartum benefits

• SUPPORT HB 354 (Davidson), SB 45 (Gannon), SB 183 (Arthur) which extends Show-Me Healthy Babies Program benefits from 60 days to one year following the last day of their pregnancy.

• SUPPORT SB 183 (Arthur) which changes MoHealthNet’s eligibility re-verification and renewal process to follow federal regulations.

Other Important Legislation

• OPPOSE SB 289 (Moon) – This bill repeals the Prescription Drug Monitoring Program (PDMP) passed by the legislature in 2021. The MAFP supports the use of the PDMP as a strategy to combat the prescription drug epidemic.

• OPPOSE HB 757 (Mayhew) – Medical school trains students to become residents, not physicians. Residency provides graduated responsibility, oversight, and progressive duties to many different patients (chronic and complex conditions), pathologies, practice settings, and undifferentiated signs and symptoms which require critical thinking and differential diagnosis. Although this measure includes educational requirements for licensure, there are issues with the requirements of third-party credentialling organizations.

• SUPPORT HB 285 (Lewis), HB 348 (Coleman), HB 407 (Doll), SB 393 (Bernskoetter) – With the expansion of telehealth and the workforce shortage, we support the need to join the Interstate Medical Licensure Compact based on the Missouri Board for Registration of the Healing Arts oversight. Board certification should not be required for physician participation or licensure. The MAFP will continue to monitor these bills to ensure appropriate language is utilized.

• OPPOSE HB 489 (Baker) SB 410 (Koenig) – The guidelines for curriculum and accreditation for medical schools and residencies have been developed based upon clinical practices that support people and healthy communities. We oppose curriculum mandates on medical education as well as any specific continuing medical education topics for licensure. Diversity, equity and inclusion (DEI) have been included in the medical school and residency curriculum for over 30 years and ensures Missourians have the support needed to overcome social determinants of health. Family physicians provide care based on the patient’s needs, not on DEI ideology.