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Work force proposals may endanger patient safety, professional standards


In this column, Ross E. Weber of the AACU examines where various proposals to address the specialist physician shortage currently stand.

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

In the AACU’s Work Force Shortage Solutions series, published on UrologyTimes.com throughout 2014, various proposals to address the specialist physician shortage were introduced to readers with the hope of generating interest and debate within the urologic community.

With nearly every state legislature currently meeting for the first time since that series was published, it’s worthwhile to examine where things stand in the defense of patient safety and high professional standards.

Med school grads stuck in residency bottleneck granted 'Assistant Physician' license

Legislators in Arkansas and Oklahoma are considering measures to create a new provider license category for medical school graduates who do not matriculate to a residency program. AR HB 1162 and OK SB 712 were inspired by Missouri's 2014 "Assistant Physician" law, which drew the ire of the physician assistant community. Physician assistants argued that creating "assistant physicians" would confuse patients and undermine the non-physician providers' successful patient education efforts.

RELATED: States take novel steps to address work force shortage

Both Arkansas and Oklahoma legislators seem to have heard that message loud and clear. In Arkansas, the new class of providers would be named "Graduate registered physicians." Oklahoma, meanwhile, chose to classify the medical school graduates as "training physicians.”

Each state proposes similar qualifications for such a license, including, but not limited to:

  • graduation from an accredited U.S. medical school

  • successful completion of Steps 1 and 2 of the U.S. Medical Licensing Exam (or an approved equivalent)

  • entering into a physician supervision protocol (Arkansas) or physician collaborative practice agreement (Oklahoma) within 6 months of licensure.

Next: Calif. NPs press for expanded scope of practice

More from the AACU

JAC 2015 preview: Hope for SGR’s demise

Congress guts the IPAB, then takes on its role

Supreme Court case may impact state scope of practice laws


California NPs press for expanded scope of practice

Undeterred by California physicians' show of strength in defeating a 2014 ballot measure that would have weakened the state's landmark medical liability law, organizations representing nurse practitioners secured the introduction of a measure to expand the non-physician providers' scope of practice (SB 323). According to California Healthline, the current proposal is similar to a bill that passed the Senate in 2013, but stalled in the Assembly Committee on Appropriations. The bill's sponsor, Sen. Ed Hernandez, strangely points to a dearth of primary care providers as the key reason why this bill to grant prescriptive authority to nurse practitioners should sail through the legislative process in 2015.

READ - States push independence for NPPs: A solution to work force crisis?

Pay equality not sufficient for Oregon nurses

After securing "equal pay for equal work" in Oregon, nurse practitioners are seeking to increase the number of health care procedures they are eligible to perform. Current law prohibits nurse practitioners from executing voluntary sterilization procedures, regardless of gender. Introduced Jan. 12, 2015, by Rep. Rob Nosse and Sen. Michael Dembrow, a noted anti-integrated care lawmaker, HB 2678 amends the law to allow nurse practitioners to perform male sterilization. AACU Distinguished Leadership Award honoree, Sen. Alan Bates, DO, testified in support of the measure, but, according to the Lund Report, recommended that its scope be narrowed so nurse practitioners can only perform simple vasectomies in an outpatient setting.

ALSO SEE: Payers, not states, often dictate non-physicians’ authority, reimbursement

Next: Telemedicine compact usurps state authority to license physicians


Telemedicine compact usurps state authority to license physicians

More than three dozen states have introduced the Federation of State Medical Board’s (FSMB) Interstate Medical Licensure Compact. The general view extolled by news outlets and medical associations belies the fact that if a sufficient number of states approve the measure, the authority of legislators and licensing boards would be questioned, if not compromised. When questioned about the authority of states to require benefit managers' decisions to be made by a physician licensed in that state (WA HB 1471 / SB 5560), FSMB Senior Director for Legal Services Eric Fish responded:

The Compact is designed to facilitate the granting of a full and unrestricted medical license. Once granted, physicians are bound to the laws of the state where the patient is located. This applies both to standard of care issues as well as any other requirements for medical care necessitated by that state's laws.

READ: Legal hurdles may stall telehealth’s role in work force crisis

While the legislation referenced here may be of varying degrees of concern to urologists, a number of positive work force measures are under consideration, including state-funded residency programs in Georgia and Idaho, as well prohibitions on tying licensure to meaningful use of electronic health records and maintenance of board certification.

The AACU is dedicated to bringing these issues to urologists' attention and developing resources that facilitate engagement in political and policy-making processes. Feedback and alerts from the diverse urologic community of providers, patients, and partners are always welcome.

Click here for all articles in the AACU Work Force Shortage Solutions series.

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