Expanding access to health care | Feb. 16, letter
Physicians are key to quality care
The letter writer says that expanding the scope of practice for advanced registered nurse practitioners, namely to allow them to practice with less direct supervision, could improve access to primary care and save money.
It is important to understand what differentiates a nurse practitioner from a medical doctor. A nurse practitioner completes a four-year degree in nursing and then two more years to acquire a master's degree in ARNP. They unquestionably have clinical experience after having worked as nurses under the supervision and guidance of physicians. They are bright and motivated women and men who certainly provide invaluable service to medical practices.
A medical doctor completes a four-year degree, typically, in sciences. In my case I have a bachelor's degree with a major in chemistry and a minor in biology. From there the medical doctor completes four more years to earn a doctoral degree in medicine. These four years include comprehensive and intense courses in human anatomy, histology, biochemistry, microbiology and pharmacology before embarking in clinical rotations. These preparatory courses give us a very broad understanding of the human body, how it works and the nature of the ailments that affect it. After completion of the doctoral degree, physicians will spend from three to seven years, depending on the specialty, of more supervised training before stating a practice independently.
I have a very high opinion of ARNPs. I work with two of them in my practice. They are of great help and allow us to provide the service our patients need promptly. They are able to treat different problems, but, invariably, given their limited training in comparison to a physician's, they require constant guidance and supervision so that the patient's quality of care is adequate.
To allow them to work unsupervised on a consistent basis would be a mistake. They are admirable, dedicated health care providers who can make a physician's practice more effective and efficient. Physicians, they are not.
Jesus L. Penabad, M.D., Tarpon Springs
Fix flood insurance reform, don't delay it Feb. 14, commentary
Competition in insurance
It's reassuring that with regard to the National Flood Insurance Program, elected leaders including U.S. Rep. Dennis Ross, R-Lakeland, are "committed to finding a practical and more affordable long-term solution that protects Floridians." While NFIP worked in the past, today it threatens homeowners and we have to deal with the consequences. However, there are proposed solutions that will help consumers.
The first private primary flood policy sale by Homeowners Choice Property & Casualty Insurance Co. is an example of competitive markets at work, giving Floridians a much-needed choice. As the Times has noted, Florida is a "donor" state in NFIP, meaning we pay in more than we get back. Private policies are a clear indication that insurance companies recognize this and are willing to write policies at affordable rates based on actual risk. A private market policy also promotes competition and gives options to consumers. Consumers need a robust insurance market, and we are encouraged the experiment with private market flood insurance has begun.
During the 2014 state legislative session, the Florida Legislature will consider Senate Bill 542, which aims to further encourage the private market to offer flood solutions to Floridians. There is no appetite for a national catastrophe program, so at this time the private market may be the best available option for many if insurers are willing and able to vie for our business.
Florida's housing market has also been affected by NFIP. In response, Democratic congressional candidate Alex Sink called on the Federal Emergency Management Agency to provide consumers with reasons for their flood ratings based on new mapping and affordability studies, an idea also supported by Rep. Ross. Consumers would be empowered to challenge the assumptions and get their rates changed. Sink's ideas will help reinvigorate the real estate market and protect property values.
These good ideas and smart solutions put Florida on a necessary path to addressing issues with flood insurance in a way that works for consumers.
Bill Newton, executive director, Florida Consumer Action Network, Tampa
Florida's a war zone
Florida has become a war zone, where daily one risks life and limb out in public because of the mentality of residents and the NRA on concealed weapons and "stand your ground." There are people with guns everywhere: in the malls, gas stations, movie theaters, educational institutions, professional offices, parking lots and, yes, churches. If I hadn't lived in Florida for 40 years, I certainly would not visit here now.
Florida has gone bonkers, round the bend and back again. We embrace violence and have made it a tradition, as homemade as apple pie. And for the life of me, I cannot comprehend why anyone needs to carry a concealed weapon, a true sign of insecurity and paranoia.
Joan Lund, Tampa
Verdict mixed in music killing | Feb. 16
Verdict's dangerous logic
So Michael Dunn was not convicted of killing a young man, however he was convicted of "trying" to kill three others. The jury, after considering the blatantly coached fear phrase, "clear and present danger," grappled with reality vs. Florida law, and then couldn't agree on murder but could agree on attempted murder.
Applying that logic, had he killed all four occupants, he would have walked. So the lesson to all the insecure, trigger-happy sociopathic gun bearers out there is to kill everyone in the SUV or theater or mall or school, to ensure that you are covered by the law. Welcome to the Sunshine State. Hope you brought your body armor.
Bob Dodd, Dade City
A call to action
The front page of Sunday's Times — greyhound racing deaths, the Jacksonville killing, and the failure of state government to provide benefits that are owed to its citizens — cried out with cruelty.
We speak of the "culture of death" and the trivialization of life in our society. But what do we do about it? We all need to participate in a citizens' call to action. I see this as good journalism, shaking us all up to participate in a culture of life.
Florence Laureira, Hudson