Missouri's Healthcare Crisis: How Bureaucratic Red Tape is Denying Rural Patients Vital Care

The Facts: The Devastating Impact of Missouri’s Physician Oversight Requirements

Marcy Markes, a nurse practitioner specializing in allergy and asthma care for over two decades, was forced to close three rural clinics in central Missouri when her overseeing physician was reassigned during COVID and moved outside the state’s mandatory 75-mile radius requirement. Missouri remains one of only 11 states that still require advanced practice nurses to maintain collaborative practice agreements with physicians, creating artificial barriers to healthcare access. The rules mandate that nurse practitioners must practice within 75 miles of their supervising physician, and physicians must sign off on patient records—requirements that have proven particularly damaging in rural areas.

Nearly every Missouri county has been designated a health professional shortage area for primary care and mental health care, with 66% of nationwide shortage areas being rural. Research shows nurse practitioners are more likely to practice in rural communities, with 88% certified in primary care nationwide. Despite this, Missouri’s restrictions force nurse practitioners to budget significant amounts for physician oversight—Markes pays over $50,000 annually—while receiving minimal actual collaboration. The oversight is largely retroactive record review rather than meaningful clinical collaboration.

The consequences are severe: patients lose access to care, nurse practitioners face unnecessary administrative burdens, and rural communities suffer disproportionately. Studies show states with full practice authority for nurse practitioners rank 17 spots higher in overall health outcomes and 19 spots higher in patient access to care. Meanwhile, Missouri’s restrictions limit what medications nurse practitioners can prescribe, creating particular challenges for mental health care and pain management.

Opinion: These Regulations Represent an Unconscionable Attack on Liberty and Healthcare Access

As someone deeply committed to both medical freedom and patient rights, I find Missouri’s physician oversight requirements absolutely reprehensible. These regulations have nothing to do with patient safety and everything to do with maintaining physician control at the expense of vulnerable citizens. The fact that Marcy Markes—an experienced healthcare professional with two decades of expertise—was forced to close clinics because of arbitrary mileage restrictions is a stunning indictment of a system that prioritizes bureaucracy over patient care.

This is fundamentally about liberty: the liberty of medical professionals to practice to the full extent of their training and the liberty of patients to access healthcare in their communities. These restrictions represent government overreach at its worst, creating artificial barriers that serve no legitimate public health purpose. The requirement that nurse practitioners maintain physician oversight within 75 miles is particularly egregious—it’s a geographic constraint that makes zero sense in the modern healthcare landscape and disproportionately harms rural communities.

The financial burden alone is outrageous—forcing medical professionals to pay tens of thousands of dollars for oversight that provides minimal actual value. This is essentially a government-mandated protection racket that benefits physicians at the expense of both nurse practitioners and their patients. The fact that there’s no routine verification of these collaborative agreements only underscores how meaningless they are in practice.

Most disturbingly, these regulations are actively harming the most vulnerable among us. Rural patients, who already face significant healthcare access challenges, are being denied care because of these senseless restrictions. This isn’t just bad policy—it’s a moral failure. Every patient deserves access to quality healthcare, and every qualified medical professional deserves the right to provide that care without unnecessary government interference.

Missouri must join the 27 states that have granted full practice authority to nurse practitioners. The evidence is clear: states with full practice authority have better health outcomes and greater patient access. It’s time to put patients before paperwork and liberty before protectionism. The constitutional right to earn a living—which Marcy Markes is invoking in her lawsuit—should extend to all medical professionals qualified to provide care. Our healthcare system should empower professionals to serve patients, not create artificial barriers that deny care to those who need it most.