2018 Advocacy Preview: Protecting the Practice of Medicine

Date of Publication December 15, 2017

Every year, proposals are put forward at the capitol to allow non-physicians to provide services that traditionally have been provided by a physician or under the direct supervision of a physician. In an era of growing provider workforce shortages and a greater emphasis on total cost of care, so too has the number of scope expansion proposals coming before the legislature grown.

The Iowa Medical Society recognizes that the practice of medicine is changing and that roles within the care team must also adapt to keep pace. This is why IMS has in recent years made a greater effort to critically examine the specific details of individual scope expansions, rather than simply opposing every measure that comes forward. IMS’ legislative advocacy is guided by our core purpose — to ensure the highest quality of health care in Iowa through our role as physician and patient advocate.

The quality of care and the safety of every Iowa patient is our paramount objective when examining scope of practice proposals. When a proposal is put forward to allow practitioners with insufficient training to safely provide a service or treatment, IMS has and will continue to strongly oppose such measures. In 2018, this standard will continue to be applied to expected legislation, such as a measure pushed over the last two years to allow optometrists to perform injections and any surgical procedures using injectable anesthesia, so long as they do not penetrate the globe of the eye. Such delicate procedures can not safely be performed without the advanced training that comes with medical school, residency training and, for the vast majority of procedures that would be allowed under such a proposal, without specialized training in the field of ophthalmology. IMS, in partnership with the Iowa Academy of Ophthalmology, has successfully halted this legislation in past years and expect to see similar proposals put forward again in 2018.

The practice of physician assistants is another area that has seen significant activity in recent years. As healthcare providers increasingly move into employment arrangements that diminish their individual autonomy, physician assistants and their supervising physicians have increasingly been placed in questionable practice arrangements that have resulted in significant communication and processes failures, increased complaints to professional licensing boards and, in at least one case, the death of a patient. The lack of clear minimum standards for appropriate supervision arrangements and lax enforcement of requirements already on the books led to these situations and provided an obvious policy solution.

Over the past two years, the legislature and the Board of Medicine have taken a series of steps, which IMS has strongly supported, to stabilize and clarify appropriate supervisory standards. Through statutory changes and new administrative rules that went into effect last fall, the State is ensuring physicians truly know when they are responsible for oversight of a physician assistant’s practice and ensuring that regular communication occurs between these two practitioners. Some have opposed the enactment of these measures and we may see attempts in 2018 to reverse the progress that has been made in ensure a return to safe, equitable supervisory arrangements.

IMS, through its new Committee on Legislation, will thoroughly review each proposed scope of practice expansion with an eye toward patient safety and ever-mindful of our core purpose. For more information on this advocacy priority or any other proposed 2018 IMS Legislative Agenda, please contact Dennis Tibben with the IMS Center for Physician Advocacy.

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