Scope of Practice: Update and Call to Action

  • Zakowski, Mark, MD
| Jul 08, 2013

The voice of the CSA and physicians in California regarding the political agenda of some groups to expand scope of practice for non-physician health care providers must reach legislators in Sacramento and continue to be heard. The messages of the critical importance of physician-led care and patient safety need to be reinforced with this audience. As such, the CSA continues to work to have an impact on the many bills of interest to anesthesiologists currently being considered in the legislature. Let me update you on three bills of particular concern and encourage you to add your voice to the collective efforts of this Society and its partners.

The Scope of Practice Bills (SB 491, SB 492 and SB 493) have been passed out of the state Senate and into the Assembly Business & Professional Committee. After a vote on August 6, the bill will move from committee to the final vote in the full assembly, and then presumably onto the governor’s desk. Right NOW is the best opportunity to take action and tell your Assembly Member to vote NO on these bills. The CSA and the CMA are urging you to call your legislators and ask for NO votes on SB 491, SB 492 and SB 493. These three bills will expand scope of practice and remove the required and necessary supervision by a physician and surgeon, ultimately potentially harming patients while decreasing quality of care.

Take action now: contact your legislator through the CSA Grassroots Network.

As a reminder, here are some legislative summaries from CMA:

SB 491 (Hernandez) – This bill would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive drugs without supervision. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education that physicians do in order to be qualified to practice medicine without physician involvement.

SB 492 (Hernandez) – This bill would allow optometrists to provide primary care service including diagnosing diabetes, high cholesterol and hypertension. Under this bill, optometrists would be able to examine, prevent, diagnose and treat any disease, condition or disorder of the visual system, the human eye and adjacent related structures.

SB 493 (Hernandez) – This bill would allow advanced practice pharmacists to evaluate and manage diseases and health conditions without physician consultation. Additionally, any pharmacist would be able to furnish prescription smoking cessation drugs and devices with known harmful side effects including depression and in some cases, suicide.

Legislators need to know the true impact these bills would have in their districts. Your calls are imperative to help us stop these bills and protect patients. Contact your legislators TODAY and urge them to vote NO on SB 491, SB 492 and SB 493!

Current requirements around physician supervision of allied health professionals are not mere formalities or bureaucratic barriers to care. The physician-led care team has existed for decades, and with good reason! These requirements are in place to ensure that patients receive high quality care by practitioners qualified to deliver that care. With years of graduate training, full-time residencies and thousands of hours of clinical rotations, physicians are uniquely equipped with the necessary knowledge and understanding of complicated and hard-to-diagnose, hard-to-treat diseases.

To help you in your outreach, here are some suggested Talking Points from CMA:

SB 491, SB 492, and SB 493 harm patient safety, plain and simple.

Other health professionals, while hugely important to the health care delivery system and an integral part of medicine, are not trained to diagnose and treat diseases like physicians are.

Rather than further fragment the health care delivery system, we need to be looking at integrated care models that utilize everyone to the best of their abilities.

We believe patients are best served when they are provided with meaningful access to safe medical care provided by medical teams led by highly trained and qualified physicians.

To ensure patient safety, medical care must be administered in coordinated teams led by experienced, fully trained, qualified physicians.

There are very real consequences for Californians if these bills pass. SB 491, SB 492 and SB 493 will allow NPs, optometrists and pharmacists to practice medicine without being subject to the controls and oversight of the Medical Practice Act. The end result would be that these specific health practitioners would be held to a lower standard of care than physicians providing the same service.

If passed, these bills will allow also non-physicians the ability to prescribe dangerous medications such as opioids. The Registered Board of Nursing is simply not equipped to oversee such prescribing and does not have an investigatory arm, as the Medical Board of California does. In my own experience, undertrained professionals order more tests and imaging studies as well as send patients for more referrals than do physicians.

Proponents of these bills are using the guise of health care reform to say that independent practice will expand access to care. That is just not the case. The same economic factors that I face as a physician will impact NPs, optometrists and pharmacists. When communicating with your legislators you may personally expand on the economic challenges you face every day).

The number of physicians in California is unevenly distributed with regard to the general population, but these bills do not solve the problem. The majority of allied health professionals are practicing in the same regions as physicians now. There is no proof that indicates NPs, optometrists and pharmacists will indeed move to rural or underserved areas should scope of practice expand.

I urge you to learn more about these pertinent issues and add your voice to the call for putting patient safety first. Contact your legislator. Take action now.



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