Thank you for the opportunity to provide public comment. I have been a nurse practitioner (NP) for 13 years practicing on the Eastern Shore of Virginia.  We are an underserved, low socioecomonic community. As physician retirements  increase, the use of locum tenens has become the norm.  This practice limits the ability for NPs in this area to identify an active physician with whom they have practiced for 5 years.  An employer or health system  however, could verify practice length and status. I would ask that you make this process flexible to accomodate those of us who serve in underserved communities where physician turnover is high and the use of locum tenems is the norm.