From the moment the practice of medicine was defined, those with
lesser education, differing world views of health care, and/or
naiveté toward patient safety concerns have displayed expansionist
tendencies into services and treatments long considered and legally
defined as the practice of medicine.
With arguments both scientific and political, proponents have
attempted to nibble away at the edges of medical practice for their
own economic benefit. As a matter of strategy, however, the
economic side of the issues generally was downplayed while the
righteous aspects of "turf battle" were stressed. Each nonphysician
group attempted to present its arguments for expansion as a
disagreement between two equally trained - or essentially so, they
argued - groups of practitioners.
More often than not, members of the legislature have been placed
in the uncomfortable position of having to choose between friends -
physicians and those who would challenge the definition of what
constituted an act or service encompassed by the practice of
medicine. The challenge to each group of nonphysician practitioners
was to pursue a single issue. The challenge to physicians and their
professional associations has been to defend against all incursions
into medical practice while simultaneously pursuing a broad
legislative agenda in which scope of practice was but one of many
priorities.
With each ensuing battle, the rules of engagement have evolved.
For the second session, the Patients First Coalition, representing
TMA and the major medical specialty societies in the state, played
significant roles. This cooperative approach has created new allies
in the debates at just the right time. Today, rather than face
multiple single opponents, we also face a coalition of these
like-minded groups operating in a coordinated manner, each
attempting to buttress both scientific and political arguments for
their causes to support expansions.
In 2007, nearly 90 bills were filed that dealt in some ways both
major and minor with expansion of scope of practice. No significant
proposal impacting medical practice and patient care was passed.
Even an agreed-to bill with the acupuncturists failed to move out
of committee. In some ways, members exhibited "issue fatigue" and
wanted to avoid the confrontational aspects of scope issues. But,
an aggressive strategy by the Patients First Coalition also helped
to divert some of our adversaries' attention and resources.
Nevertheless, with Sunset review of the Medical Practices Act in
2005 and the Nursing Practices Act in 2007 having been completed
for this cycle, the field is open in 2009 for the 81st Texas
Legislature to consider a significant amount of scope legislation,
primarily in the expansion of practice for advance nurse
practitioners.
The
Retail Health Clinics
issue (covered elsewhere in this compendium) served as a nexus for
scope of practice and access to care issues, but it also included
economic arguments as well. We expect this to be the tip of the
spear on scope issues for the next session.
Scope of Practice Near Misses
House Bill 1117 by Rep. Betty Brown (R-Terrell) would have changed
the language of who may file a birth certificate. The bill would
have changed the language from "physician, midwife, or person
acting as midwife" to "physician or other health care
practitioner."
House Bill 3115 by Rep. John Zerwas, MD (R-Richmond), would put
in place requirements to better inform patients and the public
about the distinction between a physician and others in health care
who use the title "doctor ." The bill would have required
practitioners, excluding physicians, who use the title of doctor to
communicate to a patient orally or in writing, including on a name
tag, the type of license, permit, registration, or certificate
under which the person is practicing. At least one other state has
passed similar legislation. A violation of this requirement would
have made the practitioner subject to action by the appropriate
oversight board as grounds for revocation or denial of license,
permit, registration, or certification. The bill was heard in the
House Public Health Committee, but did not have sufficient votes to
advance further.
Scope of Practice TMA Staff Team:
Legislative: Dan Finch
Policy/Legal: C.J. Francisco
Overview
|
Managed Care/Insurance Reform
|
Retail Health Clinics
|
Responsible Ownership
|
Corporate Practice of Medicine
|
Health Care Funding
|
Medicaid, CHIP, and the
Uninsured
|
Public Health
|
Border Health
|
Mental Health
|
Emergency Medical Services and
Trauma Care
|
Rural Health
|
Medical Science and Quality
|
Physician Workforce, Licensure,
and Discipline
|
Health Information Technology
|
Prescription Drugs
|
Long-Term Care
|
Workers' Compensation
|
Abortion
|
Franchise Tax Reform