Faced with severe worker shortages of doctors, dentists and other health care professionals, Michigan is considering filling the gap by expanding roles for some workers, like nurse practitioners, and even creating entirely new health care job categories.<\/p>\n
State lawmakers are proposing a couple of fixes:<\/p>\n
1. Allowing nurse practitioners to prescribe and dispense controlled substances without a doctor\u2019s authority. State law currently restricts NPs from \u201cfull practice authority.\u201d<\/p>\n
2. Temporary licenses allowing certain doctors who earned their degrees outside the US or Canada to practice in Michigan.<\/p>\n
3. Joining interstate compacts, which would allow providers licensed in other states to practice here and have their local counterparts the ability to practice out of state. <\/p>\n<\/ul>\n
Michigan is also expanding the use of other health care professionals like dental therapists to care for patients in areas lacking in dentists. This comes after the state in 2008 agreed to allow the creation of the profession.<\/p>\n
The need is immediate.<\/p>\n
As Michigan ages<\/a>, there\u2019s \u201ca larger need for health care,\u201d said Jason Lachowski, associate state director of government affairs of AARP Michigan. The organization, representing 1.3 million members, supports bills that would expand roles for nurse practitioners and allow other professionals to work across state lines.<\/p>\n As Bridge has previously documented<\/a>, Michigan suffers severe shortages in health care \u2014 from primary care doctors<\/a> to psychiatrists<\/a> to medical assistants<\/a> to pharmacy techs<\/a>.<\/p>\n \u201cIf we are trying to open pathways for people in communities that need (to be) better served, we have to do something differently,\u201d said Misty Davis, who has been overseeing efforts at the Michigan Primary Care Association to place dental therapists<\/a> into areas without enough dentists.<\/p>\n But doctors, dentists and others at the top of the delivery system worry that expanding the roles of \u201cmid-levels\u201d such as nurse practitioners, physician\u2019s assistants and dental therapists, would confuse \u2014 and even endanger \u2014 patients.<\/p>\n A \u201cdoctor\u201d of nursing? A physician \u201cassociate?\u201d A nurse \u201canesthesiologist?\u201d<\/p>\n The ever-expanding terminology and expansion of professional licensing can cause \u201cconfusion\u201d for patients who are already navigating a \u201ccloudy environment\u201d in the state\u2019s health care system, said Dr. Tom George, the CEO of the Michigan State Medical Society.<\/p>\n \u201cWe have a shortage (of physicians) and we recognize the modern practice of health care uses multi-disciplinary teams,\u201d George said. \u201cPatients in Michigan deserve to have a physician available for their care.\u201d<\/p>\n Debating the role of nurse practitioners <\/p>\n But Michigan\u2019s rules are \u201coutdated\u201d by comparison to some other states, said Naila Russell, a nurse practitioner based in Traverse City.<\/p>\n Among other things, they block her ability to prescribe controlled substances to patients who need them, she said.<\/p>\n \u201cIn Michigan, you are still required to have a delegating physician,\u201d Russell explained.<\/p>\n Russell, who acts as the legislative chair for the Michigan Council of Nurse Practitioners<\/a>, said the controlled-substances delegation remains one of the last hurdles her profession faces.<\/p>\n \u201cWe can\u2019t operate in a rural setting where there are no physicians who will delegate to you.\u201d<\/p>\n Physician advocates like George, whose organization represents the state\u2019s medical and osteopathic doctors, oppose multiple<\/a>legislative efforts<\/a> to grant nurse practitioners full practice authority.<\/p>\n Other states\u2019 expanded scope of practice have \u201cnot made a dent\u201d in making care more accessible to patients, George said. He points to studies that indicate some independent nurse practitioners take on non-primary care roles like cosmetic and IV hydration services<\/a>. <\/p>\n While NPs \u2013 some of which have doctorates in nursing practice \u2013 are reimbursed by Medicare at about 85% of a physician rate, George is not convinced a change in practice authority would amount to savings, pointing to research that shows a rise in costs related to the nurse practitioners\u2019 higher use of services<\/a> like imaging and referrals compared to doctors. He worries that having more providers able to prescribe opioids<\/a> would be a \u201cstep backwards\u201d for Michigan.<\/p>\n However, a 2024 border analysis<\/a> comparing states with full practice authority indicates measurable health improvements among patients. Other studies indicate NP roles can lead to cost savings among some patients<\/a> while improving patient satisfaction and wait times<\/a>. Proponents of nurse practitioner reform say the state has enough built-in opioid prescription guardrails to stop bad actors from taking advantage of the system.<\/p>\n Still, George said he\u2019s open to modifying the current regulation.<\/p>\n \u201cWe\u2019re at one extreme \u2013 we require supervision. And at the other extreme, you have total independence,\u201d George said, calling for a more \u201cflexible\u201d written practice agreement that keeps doctors at the top of overseeing nurse practitioners.<\/p>\n The Citizens Research Council of Michigan is generally supportive of expanding scope of practice, concluding in a 2024 policy brief<\/a> that financial costs from increased utilization should be weighed against \u201cthe significant toll the primary care provider shortage has on the public health and financial wellbeing of the state.\u201d<\/p>\n Boots on the ground<\/p>\n In yet other cases, lawmakers are creating brand new roles in the state\u2019s workforce. <\/p>\n Medication aides<\/a> \u2014 a position that the Michigan Nurses Association opposed<\/a> \u2014 began working in Michigan\u2019s nursing homes in 2023, an industry dogged by short staffing<\/a>.<\/p>\n And late last year, Michigan\u2019s first licensed dental therapist \u2014 a mid-level position between dentists and dental hygienists \u2014 began working after the Legislature approved the role in 2018<\/a>. <\/p>\n It took seven years for the state to set up administrative rules and rework Medicaid so that the aides could be paid. And a training program \u2014 the first will be at Ferris State University<\/a> \u2014 won\u2019t start for another few years.<\/p>\n \u201cThere are significant pieces that need to be worked out before we get boots on the ground,\u201d Davis, at the Michigan Primary Care Association, said.<\/p>\n Nearly a decade ago, the Michigan Dental Association argued<\/a> against the creation of dental therapists. President Dr. Cheri Newman told Bridge earlier this month it would have better served Michiganders to grow the current workforce of dentists and dental hygienists instead, with better outreach to high school students and expanded mentorships.<\/p>\n But others say too many Michiganders go without dental care as the state tries to recruit more dentists to underserved areas \u2014 positions that typically require eight years of school. <\/p>\n Dana Obey, Michigan\u2019s first dental therapist<\/a>, required instead just three years of school, and she began work in September at Bay Mills Health Center<\/a>, a community clinic that serves under- and uninsured residents in the Upper Peninsula.<\/p>\n She was in her late 30s with infant twins when she decided to advance from a dental assistant to dental therapist. <\/p>\n With scholarships and financial help from the Michigan Primary Care Association, Obey attended dental therapy school in Washington state.<\/p>\n Building up the workforce of dentists sounds great, Obey said, but it\u2019s impractical. <\/p>\n Dentists face hundreds of thousands of dollars in student loan debt \u2014 estimates have hovered around $300,000 in recent years, according to the research organization Education Data Initiative<\/a>.<\/p>\n As a result, they\u2019re more likely drawn to private practice in more densely populated areas \u2014 not low-paying public health-related dentistry in Michigan\u2019s rural stretches.<\/p>\n \u201cThey are just finishing school with so much debt, and then you want them to go and work for pennies?\u201d she said.<\/p>\n Next steps<\/p>\n The Michigan Academy of Family Physicians also opposes expanded roles for physicians assistants<\/a>, arguing that fully-trained medical doctors have \u201cdistinctive skills, training and experience. Likewise, a bill to expand roles for nurse practitioners, it contends, is \u201c dangerous legislation<\/a>.\u201d<\/p>\n The group also rejects proposed legislation that would establish temporary licensing for some internationally educated physicians<\/a>, saying the bill lowers the standard of patient care.<\/p>\n Advocates for older residents, like AARP of Michigan, encourage expanding access and improving affordability for patients as the state ages, including bills for physicians<\/a>, nurses<\/a>, physical therapists<\/a>, occupational therapists<\/a>, dentists and dental hygienists<\/a>, audiologists<\/a> and counselors<\/a> to state lines by joining interstate licensure compacts, allowing providers to live in-state and work elsewhere and vice versa. <\/p>\n Michigan is set to exit the Interstate Medical Licensure Compact<\/a> on March 28, which the AARP Michigan views as \u201cdetrimental\u201d if lawmakers fail to renew the state\u2019s agreement.<\/p>\n ___<\/p>\n