Turf wars drive healthcare costs ever higher, and Nominee #6 emerges from one of the biggest battles in Michigan today. Earlier nominations are found in your sidebar, starting with Nomination #5.
These wars over healthcare control go back at least to medieval guilds. Doctors fight each other and anyone else who tries to learn and practice at a higher level without paying dues to medicine. Their chief weapon is law, because, as a rule, medical lobbies despise competition in the open market.
Doctors also hate being called “providers,” which clumps them with nurse practitioners, physician assistants, and other clinicians. They find the term “prescriber” only slightly less demeaning.
Unfortunately for doctors, Michigan’s Code of Laws lists them as both providers and prescribers.
The Insult
As insults go in the nursing profession, “physician extender” is right up there with “doctor’s handmaid.” It is not part of Michigan law, and appears to originate with the physician lobby. It also pops up in today’s hearing, and I promise the part about your expensive healthcare is coming soon.
The American nurse is a professional who operates in three spheres, and has done so for at least 100 years. Some nursing work is independent, some is collaborative, and some is dependent on doctor’s orders. For centuries, a prime example of dependent practice is prescribing medications: the doctor prescribes, the pharmacy dispenses, the nurse administers.
Until nurse practitioners (NPs) came along.
I described on video last year the impact of today’s bill (first draft) on NPs and pain patients. NPs already write other prescriptions. They diagnose and they treat, all day long. They’re highly educated and highly trained, following a nurse-designed educational model, rather than traditional medical school internship, residency, etc.
This all galls doctors no end, chafing at their individual and collective dignity.
The Mandate
From the Michigan medical lobby perspective, the only thing worse than advanced nursing practice is taking away the law requiring NPs to contract with physicians. Twenty-seven states have already done so.
Today’s bill gives NPs a way to escape the contract mandate. As you might expect, doctors pour into the April 30, 2025 Lansing hearing room.
I identify at least four types of lying.
- red herring
- bait and switch
- half-truth
- outright lie
It doesn’t help that a misnomer made it into the official bill description. House Fiscal Agency is known for neutrality, yet says the bill would “modify scope of practice.” Technically, this means legal permission to do more things – a guaranteed red flag for the physician lobby.
A better description is “autonomy” or “full practice authority”; NPs already do the tasks in question. The alternative language might still raise ire, but would also cause less confusion.
Hearing chaos rises to such a level, the bill sponsor gets frustrated and starts to flounder.
The Nomination
Rep. Thompson steps in with a follow-up that earns her this year’s 6th nomination for the MHF Defender Award.
Cool as a cucumber, her simple question and its one-word answer slice through the confusion.Check out this sequence:
Get the context from the full hearing.(1:30)
Round 2
It took two hearings to fit in all the testimony. Maybe half of the speakers offer legitimate, relevant information. The rest only embarrass themselves, or at least their mothers.
Highlights from Round 2 (minute 45):
- Committe members take turns reeling in the rabbit trails.
- Rep. Thompson draws a line in the sand.
- Rep Tisdel sounds off at unsubstantiated claims of NP negligence (1 hour 9 minutes).
Some of the lies are so obvious, one wonders which rock the doctor has been living under. (Or do they think legislators live under one?)
$o $imple: Follow the money
The real reason for the wild claims is as easy as gradeschool math.
Multipy 13,493 nurse practitioners in Michigan by the average $534 per month charge to collaborate with a physician.
The total monthly transfer of wealth from Michigan patients through NPs to physicians comes in at $7,205,262.
The contract mandate is nothing but pure protectionism, but doctors will hardly admit that out loud. Instead, they cry patient safety.
Bottom Line: protectionism costs are ALWAYS passed along to patients. It may cost you money, it may cost you time, or it may cost you independence – but it will always cost you.
Each NP (and his or her patients) saves $6408 per year, plus daily paperwork time, if Michigan repeals the collaboration mandate.
As of this writing, HB 4399 is stalled in the House Rules Committee. Check its progress here.
