Scope Revisited

Interim Studies to Look at Proper Role of Allied Health Practitioners   

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Legislative Affairs Feature - December 2005  

By  Ken Ortolon
Senior Editor  

Organized medicine successfully banded together during the 2005 Texas Legislature to defeat all attempts by allied health professionals to expand their scope of practice. But scope of practice is an issue that never seems to go away.

That the issue will come up again in 2007 was virtually assured in October when two House of Representatives committees were directed to study three scope-related issues between now and the next legislative session.

While physicians remain wary of any attempt to broaden allied health practitioners' scope of practice beyond their training, Texas Medical Association leaders say the interim studies actually present an opportunity for organized medicine to clearly define the differences in training and education between physicians and limited license practitioners. 

Setting the Charge  

The House Public Health Committee was ordered to study "selected scope-of-practice issues related to health professions which maintain the safety of patients through demonstrated competency and education, and balance improved cost efficiency within the health care system." TMA officials say that is a very broad charge that will allow the committee to consider just about any scope issue.

The committee will evaluate the need to regulate laser hair removal facilities and certify people who perform those procedures.

Finally, the House Government Reform Committee will consider consolidating the various allied health professions licensing boards.

Both laser hair removal and consolidating the allied health licensing agencies were debated during the 2005 legislature. Lawmakers, however, left those issues unresolved.

The Texas Medical Board, formerly the Texas State Board of Medical Examiners, had proposed rules to require a physician to supervise individuals doing laser hair removal but it delayed implementation of those rules to allow lawmakers to weigh in on the issue.

During the 2005 legislative session, Rep. Vicki Truitt (R-Keller) filed legislation to require laser hair removal facilities to be licensed and individuals performing such procedures to be certified. That bill, however, failed to pass. Public Health Committee Chair Diane White Delisi (R-Temple) says House leaders agreed to the interim study when it became clear the issue could not be resolved.

The Sunset Advisory Commission staff had recommended consolidating the licensing agencies, but the recommendation was rejected by the commission itself.

TMA anticipated an interim study on scope issues and had already created an Ad Hoc Committee on Scope to take a hard look at the education, training, and expertise of the various allied health professions. Austin I. King, MD, chair of TMA's Council on Legislation, says that kind of knowledge will help physicians educate lawmakers on the proper role of optometrists, podiatrists, and other allied health practitioners.

"The problem with talking among ourselves about which privileges should be restricted to physicians and which should be given to other groups is that we don't know for sure what their background and training are," Dr. King said. "To be able to really answer those questions in depth, especially when you're talking to legislators, you have to know what training other folks have had and whether because of that training they are competent to do whatever they're asking to do."

Austin obstetrician-gynecologist Albert Gros, MD, chairs the committee. He says patient safety will be its primary focus.

TMA partnered with more than a dozen specialty societies to create the PatientsFirst Coalition to fight scope expansions in 2005. That organization will continue to represent organized medicine on scope-of-practice issues through the interim and next session. Former legislator and PatientsFirst lobbyist Jaime Capelo says focusing on training and education will help lawmakers understand that scope of practice is not really a turf battle between health professionals.

"Because the scope argument has traditionally been fought by the allied health folks as a turf and money battle, there's an unfair perception of scope as truly being nothing but doctors trying to protect their pockets," Mr. Capelo said. "A scope charge that really takes an in-depth look at the education and training of providers will certainly go a long way in demonstrating - as PatientsFirst always said and as the name signifies - that it's about patients' safety, about who is best qualified by education and training to do the procedures in question." 

Selecting the Criteria  

"Those three words - scope of practice - strike fear in the hearts of legislators because it can become extremely contentious," says Representative Delisi. She hopes to avoid that contentiousness during the interim study by judging every scope issue on a standard set of criteria. Those include the training of the various health professionals, and whether expanding the scope of a certain profession would improve Texans' health and reduce the number of health professional shortage areas.

"It's insufficient to see a flip chart that says Oklahoma does this, so, therefore, Texas should do this," Representative Delisi said. "We're going to do some digging, and the health of Texans is going to be primary.   I'm going to keep the emotional debate at bay, and we're going to talk facts."

Mr. Capelo says examining scope during the interim should take some of the political pressure out of the issue. "It's a topic that folks in the legislature typically don't like to deal with because it pits one political friend against another political friend," he said. "So a study will help from an education perspective that isn't necessarily connected to how much campaign contributions the optometrists came up with this session."

Mr. Capelo says physicians should welcome this study. "At a time when there is such flux in the medical community with the advent of all these new technologies, new pharmaceuticals, techniques, and treatments, it's an appropriate time for physicians to once again demonstrate that the physician is the captain of the ship for a reason. That reason is education and training."

Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at  Ken Ortolon.  

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