Putting the Crosshairs on Scope

For years, pharmacists, chiropractors, advanced-practice-nurses, podiatrists, optometrists and so on have fought in the General Assembly of the State Legislature for the expansion of their “Scope of Practice”, referring to the legal lines that define the limits of practice for a given healthcare practitioner, under state licensure.

MAG icon, high-resolution, July 2011For those same years, my beloved state physician association has fought on that same battleground, staunchly opposing such expansion of permissible practice for non-doctors.  This year was no exception.  MAG staff estimates they spend 70% of their year on this sole topic, giving less time to address other pressing matters (health insurance exchanges, payment reform, industry upheaval).

crosshairsPerhaps there is a more efficient way for the professional advocacy groups to spend our time.  Perhaps we can emphasize our common ground and explore root causes of the conflict, then seek a negotiated agreement for the betterment of Georgians and each professional discipline.  Perhaps its time to put the crosshairs on Scope.

Let’s begin with examining root causes of the conflict:

  1. some of the conflict has to do with money: by expanding the limits of practice for non-physicians, the latter can earn more money, at the expense of physician income
  2. some of the conflict has to do with clinical disagreement; podiatrists feel their (no pun intended) sole focus on the feet should empower them to perform more operations on the feet, whereas orthopedic surgeons feel their expansive training and surgical experience is better suited to create an optimal surgical outcome for complex conditions of the feet
  3. some of the conflict has to do with varying assessments of unintended risk to patients; what if, in giving pharmacists the right to administer pediatric vaccinations, kids saw their pediatrician less, leading to missed interventions for scoliosis, developmental delays, sexual health or abuse?

Beyond self-interests, I believe each professional group has altruism in their heart, wishing to improve the health of the communities they serve.  If so, could we agree that any negotiated change in Scope of Practice fulfill two premises:

#1 the proposed change in scope must have sound clinical evidence to support it (see my many previous posts on evidence-based-medicine [EBM]); for example, the requested increase in scope of practice must not only be supported by proof of expanded abilities of the health profession in question, but must also be proved (from a modest clinical trial) to likely “do good and no harm”

#2 the proposed change in scope must be in the public’s best interest (e.g., making low-risk influenza vaccine more accessible to citizens by granting pharmacists the ability to administer them)

team careMAG must maintain its role as the leading voice of Georgia healthcare. The citizens and legislature of Georgia will judge us by our ability to effectively work with, not against, the other healthcare constituencies who deliver care in Georgia.  Let us physicians make the first move to reach agreement on a scope of practice issue that promotes quality, access, affordability and safety with at least one of our healthcare colleagues in pharmacy, nursing, or another field before the 2014 legislative session.

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