While rapidly transitioning between topics in an interview about his professional practice, his patients and state restrictions, Thomas periodically swivels in his chair to type on his computer and to answer phone calls. He then leaves his small office and takes a few minutes to check on a patient, then quickly returns to continue his discussion.
For the last 13 months since the nurse practitioner opened his practice, Pediatrics Plus in Anniston, Thomas has displayed this energetic spirit, working almost continuously to serve his patients.
He has remained on call every day since he opened, including weekends. Last flu season, he treated 500 children in three months and expects to treat double that amount this year.
The Nurse Practitioner Alliance of Alabama recently acknowledged Thomas for his efforts with an award for best nurse practitioner in the state.
“When (parents) see me come in on the weekend with bloodshot eyes, they appreciate it,” he said.
Thomas’ dedication and determination have taken him far, but Alabama restrictions are keeping him from going much further in expanding the scope of his practice.
According to the American Academy of Nurse Practitioners, Alabama places more restrictions on nurse practitioners than nearly every other state in the country. It is a reality that some experts in the field say compels many talented nurse practitioners to leave Alabama for better job opportunities and is holding back improvements in health care for many residents.
“Nurse practitioners provide a lot of rural and community care to the uninsured and underinsured,” said Cynthia Selleck, associate dean for clinical affairs and partnerships for the school of nursing at the University of Alabama at Birmingham. “The state has tremendous health care needs … nurse practitioners could be one vehicle to deal with the massive health care issues we have.”
Alabama routinely ranks high on nationwide lists for levels of health concerns such as obesity, cancer and infant mortality.
Nurse practitioners are a step beyond registered nurses, both in education and abilities. They usually work under a physician in various specialties, such as pediatrics. They can do many things a physician can, including order, perform and interpret diagnostic tests, such as lab work and X-rays; diagnose and treat acute and chronic conditions like as diabetes, high blood pressure, infections and injuries; prescribe medications and other treatments; and manage patients’ overall care.
Currently, about 1,400 nurse practitioners operate in the state, a sliver of the approximately 148,000 that operate throughout the country, Selleck said.
“The amount in Alabama is nothing compared to the amount in other states, which I suspect is because of the restrictions,” she said. “All of the surrounding states have better laws.”
Thomas’ practice is an example of Alabama’s level of restrictions. He is the only nurse practitioner to own a practice in Anniston and is one of a few who own a practice throughout the state.
“He’s fairly unique,” said Patricia Pearce, the Alabama regional director for the American Academy of Nurse Practitioners. “Most nurse practitioners here work for someone else. He’s been quite innovative.”
Under Alabama’s restrictions, Thomas is able to write prescriptions for many drugs, but not narcotics; the latter include certain medications he would need for his pediatric practice to treat illnesses such as attention-deficit hypertension disorder. And like other nurse practitioners in Alabama, Thomas is required to have a licensed physician oversee 10 percent of his cases each year. Thomas has to pay a physician to come to his practice, limiting his ability to expand, he said.
“If a nurse practitioner is working away from a physician, he’s got to go to the physician’s practice or have the physician come to him,” Selleck said. “It doesn’t help anybody, and it costs money.”
Pearce agreed that Alabama regulations were counter-productive to nurse practitioners.
“Nurse practitioners want to work collaboratively, but they don’t want to be tied down,” Pearce said. “It makes working very difficult.”
An Institute for Medicine 2010 nationwide study appears to support Pearce and Selleck’s position. The study, titled “The Future of Nursing,” made several recommendations for changes at the federal and state level regarding nurse practitioners to improve health care in the country, including removing barriers to their practice. The report stated nurse practitioners should be able to practice to the full extent of their education and training.
Nurse practitioner groups have attempted state legislative efforts in recent years to change Alabama laws, but so far, they have not had success.
Attempts to reach the Alabama Medical Association to discuss possible reasons why the restrictions should stay in place were unsuccessful.
Jennifer Ardis, spokeswoman for Gov. Robert Bentley, said Wednesday that the governor was in favor of a slight loosening of the state’s nurse practitioner regulations.
“The governor is supportive of the collaborative system we have now, but is also supportive of some flexibility to continue to provide quality health care for all Alabamians,” she said.
While he was still a state senator, Bentley in 2004 commissioned a report that called for a greater use of nurse practitioners to help the medically underserved in Alabama.
According to the report, titled “A Proposal to Increase Utilization of Nurse Practitioners in Underserved Alabama,” 60 percent of Alabama’s population resides in rural areas, but only 20 percent of Alabama’s primary care physicians (family practice, internal medicine, pediatrics and obstetrics/gynecology) practice in rural areas. The report suggested nurse practitioners could help shrink this gap, but only if certain changes were made.
The report recommended modifying the state’s regulations regarding collaborative agreements with physicians so nurse practitioners would have more freedom to help underserved residents.
“We have a shortage of providers who provide access to care,” Pearce said. “Nurse practitioners do provide primary care.”
Selleck said the April tornado disaster in Alabama was a prime example of the problem with Alabama’s restrictions.
She said after the tornadoes hit, a free clinic in Jefferson County requested nurse practitioners to help provide medical services in Pleasant Grove.
“We had people who were ready to go, but unless they had a collaborative agreement, they couldn’t do it,” Selleck said.
Despite Alabama’s restrictions, Thomas has no intention of leaving Anniston anytime soon.
“It would have been a lot easier to open somewhere else,” he said. “But there is definitely a need for more nurse practitioners around here. And I think Alabama will eventually change.”
Star staff writer Patrick McCreless: 256-235-3561.