The "scope of practice" battle

John Taylor: February 13, 20132 Comments

Dilemma: Millions more Californians getting covered by health insurance, but not enough physicians to treat them – outlook especially bleak in the Central Valley. Potential remedy: Scale back regulations and allow folks like pharmacists, physician assistants, nurse practitioners and optometrists to act as primary care providers – to do things outside their current “scope of practice.”

That hot button is currently being pressed by lawmakers in Sacramento and other parts of the country, setting off what the Los Angeles Times called a “turf war” with the physician establishment.

State Sen. Ed Hernandez, an optometrist, said he would introduce legislation giving more authority to folks like him who encounter patients who are clearly diabetic but are not allowed to diagnose or treat those patients. He must refer them elsewhere – to either wait for care or allow their symptoms to advance untreated.

The head of the California Medical Association, Dr. Paul Phinney, a pediatrician, told the Times that giving more power to non-physicians was the wrong tack to take. “Patient safety should always trump access concerns,” he said, suggesting less-educated caregivers might overprescribe or order inappropriate tests, driving up costs. Instead, he recommended that more funding go to a loan repayment program for recent medical grads who agree to practice in underserved areas.

It can take a decade or more to educate a physician. The demand for care is right around the corner. As longtime Valley resident and current head of the state Health and Human Services Agency Diana Dooley was quoted as saying in the Times: “We’re going to have to provide care at lower levels. I think a lot of people are trained to do work that our licenses don’t allow them to.”

Stay tuned.


2 responses to The "scope of practice" battle

"Lower level of care"

In refferring to the physician argument of a lower level of care from other providers; 1. Nurse Practitioners typically go through a five year rigorous course of study and clinicals to obtain a bachelors degree, then to become a NP it is an additional 2 years traditionally, with most programs switching to the Doctor of Nursing Practice (DNP) which is 3-4 years in addition to undergrad work to become a Nurse Practitioner. This course of study (with theoretical differences) is equivilent to what doctors cover in med school. The main difference is residency, MD's have structured ones, NP's do not, however there first 2-4 years on the job is a residency. The Nurse Practitioner is highly competent and I know of many who praqctice in surgery, emergency medicine, family practice, OB/GYN, Otolaryngology, and many other specialties. The problem is that the physicians want to corner the market on billing, once the hospitals embrace the NP role, the physicians will have no choice. 2. Optometrists: These guys also spend 4 years in school in undergraduate studeies and 4 more focusing on the eye, with residency. There is no reason why Optometrists should not be able to prescribe in the exact same fashion as Ophthalmologists. 3. Pharmacists: I think are great drug consultants and should be able to adjust prescriptions MD's write without consultation, as far as seeing patients, I don't think they have the skill level to take care of the whole person, but to rearrange the drug regimen of the elderly patient who is a victim of polypharmacy by over-prescribing by a physician (or other practitioner), definitely! 4. PA's: These guys think they know a lot, but most don't have the foundation to practice at the level of an MD or NP. The MD's treat them the same as NP's, which is quite an insult. 2-4 years of study for a PA compared to 7-9 for the NP makes it pretty clear that there is no comparison. Plus they do not have an independant license, they work off of a physicians license. So there is my summary and opinion. We need to open up the market to the other disciplines in medicine, whether Obamacare lasts the test of time or not.


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