Massachusetts Medical Society testifies against bills allowing increased, independent practice by non-physicians

Contact: Richard Gulla
781-434-7101
rgulla@mms.org  

Waltham/Boston -- November 19 -- Stating that physician-led teams are an essential element of high quality medical care, the Massachusetts Medical Society (MMS) today testified before the Joint Committee on Public Health in strong opposition to a number of legislative proposals that would allow increased, independent medical practice by a variety of non-physicians. 

Several physicians, including Maryanne C. Bombaugh, M.D. and Hugh Taylor, M.D., chair and vice chair, respectively, of the Society’s Committee on Legislation, testified on behalf of the organization. MMS also noted that these bills come at a time when health care delivery and payment models are moving towards integrated care models, in opposite direction of these bills.

“The movement toward accountable care organizations and patient centered medical homes requires integration and teamwork among providers to improve health care outcomes and reduce health costs,” the Medical Society said. “Physicians bring to the team the highest level of training and preparation, and thus are best suited to guide the other members of the team.” 

Among the bills opposed by the physicians’ association:

House 2009 and Senate 1709:  An Act Improving the Quality of Health Care and Reducing Costs  

These companion bills would establish independent practice for all advanced practice nurses, thereby eliminating the statutory structure underlying the physician-led teams that form the basis of quality health care in clinics, long-term care facilities, hospitals, surgery centers, limited service clinics, and everywhere patients receive medical care.

“The primary impact of these bills,” MMS testified, “would be to eliminate requirements for collaboration between the Boards of Medicine and Nursing in structuring how physicians and nurse practitioners are to integrate their practices. Advance practice nurses would be subject solely to the oversight of the Nursing Board.”  MMS further stated that “without connection to a physician-led team, as required now in law and in regulations, nurse practitioners may engage in solo practice with no limits on the medical services they provide and without the resources and safety net inherent in teams.”

MMS noted that the rationale behind the desire for independent practice by nurses is that the state and nation are facing shortages in primary care physicians. But MMS said “substituting NPs for doctors cannot be the answer. Nurse practitioners do not have the substance of doctor training or the length of clinical experience required to be doctors. Nothing in the legislation recognizes these limits in training and experience.”

House 2008 and Senate 1081:  An Act Relative to Certified Professional Midwives

These companion bills would allow the establishment of a Committee on Midwifery, within the Board of Registration in Medicine, to license and regulate professional midwives.  However, the Board of Registration in Medicine, which by statute regulates and oversees the practice of medicine in the Commonwealth, would have no oversight of the Committee on Midwifery, thereby allowing the Committee to set its own rules and regulations.

“The MMS strongly supports a role for the Board of Registration in Medicine in oversight of the practice of medical care by non-physicians,” the MMS testified, further adding that the bill does not provide “responsible oversight of currently unregulated lay midwifery but is rather the legalization of practices currently prohibited in the interest of women and children.”  MMS also noted that, while the bill refers to “certified professional midwives,” these individuals are “in reality lay midwives with no nursing or medical training” and that the training standards for meeting the designation as a certified professional are “remarkably lower” than the academic standards for those credentialed by the American College of Nurse Midwives.

House 1981 and Senate 1070: An Act Relative to Modernization of Optometric Patient Care

These proposed bills would expand the practice of optometrists by allowing them to treat all medically complex and potentially blinding eye diseases with the use of oral medications, including narcotics, without any supervision by a medical professional. They would also allow them to perform “non-invasive” surgery. In its testimony, MMS said that “optometry is a different profession from the treatment of disease, and that the prospect of optometrists treating disease through oral medications or performing any form of surgery on the eye or the face is not warranted based on the educational requirements for licensing.” MMS further testified that it “strongly believes the legislature has a responsibility to protect the public from allied health professionals who seek to unnecessarily expand their scope of practice without a corresponding increase in education and training requirements.”

House 1938 and Senate 1071: An Act Relative to the Registration of Podiatrists 

These are identical bills that would extend the practice of podiatry beyond diagnosis, treatment, and surgery of the foot to the ankle and to “include but not exceed, portions of the fibula and tibia that directly relate to the ankle.” The bill would also allow “partial” amputation of the foot, but it does not define what partial means.  In its opposition, MMS said these bills offer “an unfortunate example of non-medical doctors seeking to practice medicine without having to undergo the educational and training requirements demanded of all medical doctors nor the surgical residencies of orthopedic surgeons.” The Society further noted that “this legislation specifies no new minimum standards of education and training for podiatrists, except those that are set by the profession itself.”

Senate 1084: An Act Relative to the Practice of Psychiatry

MMS recorded its opposition “in the strongest possible terms” to this bill, which it said would “create a new standard for state mandated action.”  This bill would require all psychiatrists to participate in MassHealth (Medicaid) “in all its forms and projects as a condition of licensure” and would establish a “caseload capacity for each individual, group, or facility.”  MMS stated that this approach to psychiatric care is “blind to the variety of practice settings in which psychiatrists work as well as their individual abilities, talents, and interests,” and that the legislation “would set an unprecedented level of control over the professional lives of psychiatrists.” In concluding its testimony on this bill, MMS pointedly asked the question, “Why would a legislature that champions the freedom and rights of all individuals even consider this bill?”

Complete testimony of the Massachusetts Medical Society may be found at www.massmed.org/testimony

The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.

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